A shared decision-making communication training program for physicians treating fibromyalgia patients: Effects of a randomized controlled trial
Abstract
Objective Fibromyalgia syndrome (FMS) is a condition of chronic widespread pain that is difficult to control and is associated with strains in physician-patient interaction. Shared decision making (SDM) can be a potential solution to improve interaction. We evaluated the effects of an SDM intervention, including an SDM communication training program for physicians, in a randomized controlled trial with FMS patients. The main objective was to assess whether SDM improves the quality of physician-patient interaction from patients' perspective.Methods Patients were randomized to either an SDM group or an information-only group. The SDM group was treated by physicians trained in SDM communication and had access to a computer-based information package; the information-only group received only the information package and was treated by standard physicians. All patients were offered the same evidence-based treatment options for FMS. Patients were assessed with questionnaires on physician-patient interaction (main outcome criteria) and decisional processes. Physicians filled out a questionnaire on interaction difficulties. Assessment took place immediately after the initial consultation.Results Data from 85 FMS patients (44 in the SDM group and 41 in the information-only group) were analyzed. The mean age was 49.9 years (S.D.=10.2), and 91.8% of patients were female. The quality of physician-patient interaction was significantly higher in the SDM group than in the information-only group (P<.001). We found no differences in secondary outcome measures.Conclusions SDM with FMS patients might be a possible means to achieve a positive quality of physician-patient interaction. A specific SDM communication training program teaches physicians to perform SDM and reduces frustration in patients.
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Twelve studies explicitly reported concealed and secure allocation.
“Twelve studies explicitly reported concealed and secure allocation (Bieber 2008; Briel 2006; Chenoweth 2009; Dijkstra 2006; Kinmonth 1998; Loh 2007; Longo 2006; Smith 2006; Sorlie 2007; Stewart 2007; Wilkinson 2008; Wolf 2008).”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Bieber 2008
Thirty-two included studies randomized health providers or practices/clinics to intervention or control groups and then collected some data at the level of the individual patient or provider.
“Thirty‐two of the studies included in this review (Alamo 2002; Alder 2007; Bieber 2008; Briel 2006; Chassany 2006; Chenoweth 2009; Clark 2000; Dijkstra 2006; Fallowfield 2002; Glasgow 2004; Harmsen 2005; Haskard 2008; Hobma 2006; Joos 1996; Kennedy 2004; Kinmonth 1998; Krones 2008; Levinson 1993; Lewis 1991; Loh 2007; Longo 2006; Margalit 2005; Meland 1997; Merckaert 2008; Moral 2003; Pill 1998;”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Bieber 2008
In the majority of studies, it was unclear or unlikely that protection against contamination was adequate.
“However, in the majority of studies, it was unclear or unlikely that protection against contamination was adequate (Alamo 2002; Bieber 2008; Briel 2006;Chenoweth 2009; Dijkstra 2006; Harmsen 2005; Haskard 2008; Heaven 2006; Ho 2008; Howe 1996; Joos 1996; Kinmonth 1998; Langewitz 1998; Levinson 1993; Lewis 1991; Loh 2007; Margalit 2005; McLean 2004; Meland 1997; Merckaert 2008; Pill 1998; Robbins 1”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Bieber 2008
Twenty-eight studies made adjustments for clustering in the analysis.
“However, 28 made adjustments for clustering in the analysis (Alder 2007; Bieber 2008; Briel 2006; Chassany 2006; Chenoweth 2009; Clark 2000; Dijkstra 2006; Fallowfield 2002; Glasgow 2004; Harmsen 2005; Haskard 2008; Howe 1996; Joos 1996; Kennedy 2004; Kinmonth 1998; Krones 2008; Levinson 1993; Lewis 1991; Loh 2007; Longo 2006; Margalit 2005; Merckaert 2008; Moral 2003; Putnam 1988; Roter 1995;”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Bieber 2008
In 21 studies, no significant differences were found across study groups before the intervention.
“In 21 studies, no significant differences were found across study groups before the intervention (Alder 2007; Bieber 2008 (except lower depression scores in the non‐randomized comparison group); Briel 2006; Brown 2001; Chassany 2006; Dijkstra 2006; Glasgow 2004; Howe 1996; Joos 1996; Kinmonth 1998; Langewitz 1998; Meland 1997; Pill 1998 (except for two measures); Putnam 1988; Robbins 1979; Smith 1”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Bieber 2008
Six of the seven studies reported between one and seven outcomes on health status.
“Six out of the seven studies reported between one and seven outcomes on health status (Bieber 2008; Briel 2006; Chassany 2006; Kennedy 2004; Meland 1997; Smith 2006)”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Bieber 2008
Bieber 2008 found no significant benefit of the intervention in any of the four health status outcomes it reported.
“Conversely, Bieber 2008 and Meland 1997 found no significant benefit of the intervention in any of the four outcomes on health status they each reported.”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Bieber 2008
Bieber 2008 had high risk of bias for incomplete outcome data.
“Incomplete outcome data (attrition bias) All outcomes High risk High rate of LTFU in patients: 149/164 agreed to participate and were randomized. Only 85 of those randomized received intervention and completed baseline questionnaires.”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Bieber 2008
Bieber 2008 had low risk of bias for selective reporting.
“Selective reporting (reporting bias) Low risk main hypothesis was that SDM persistently improves physician‐patient interaction with FMS patient. Secondary endpoints were measures related to decision‐making process, coping behaviour, and directly health related outcome measures.”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Bieber 2008
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- Authors
- Bieber, C., Müller, K. G., Blumenstiel, K., Hochlehnert, A., Wilke, S., Hartmann, M., & Eich, W.
- Affiliations
- Heidelberg University (DE)
- Corresponding author
- Bieber, Christiane
- Venue
- Journal of Psychosomatic Research
- Publisher
- Elsevier BV
- Published
- 2008-01
- Volume
- 64
- Issue
- 1
- Pages
- 13-20
- ISSN
- 0022-3999 (ISSN-L)
- OpenAlex
- W1978141313
- Cited by
- 116
- References
- 57
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 7 · 2023: 3 · 2022: 1 · 2021: 4 · 2020: 5 · 2019: 12 · 2018: 2 · 2017: 8 · 2016: 4 · 2015: 7 · 2014: 8 · 2013: 11 · 2012: 10
- FWCI
- 10.49
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Psychosomatic Research (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Bundesministerium für Gesundheit
- Topics
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Keywords
- shared decision-making, fibromyalgia, physician-patient communication, chronic widespread pain, patient satisfaction
- MeSH terms
- Adult, Communication, Decision Making, Female, Fibromyalgia, Humans, Inservice Training, Male, Middle Aged, Patient Education as Topic, Patient Participation, Physician-Patient Relations, Psychophysiologic Disorders, Patient Satisfaction
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