Results Summary

What was the research about?

Shared decision making, or SDM, is a process in which patients work with their doctors to select treatments based on what’s most important to them. Doctors and patients discuss information about the health problem, treatment options, and what patients prefer.

The research team created two different training programs to help doctors and their staff use SDM with patients who have asthma:

  • Twelve-week training session. A trainer visited doctors’ offices one hour each week for 12 weeks to teach SDM. Trainers worked with the doctors’ offices to customize the process for each office. After a year, the trainer did a refresher class.
  • One-hour training session. A trainer visited doctors’ offices once for one hour to teach SDM. The trainer didn’t customize the SDM process for these offices.

The research team looked to see if patients felt more involved in decisions about their care after their doctors’ offices took part in training. The team also compared the two groups of doctors’ offices that got training with each other and with a group of offices that didn’t get training.

What were the results?

Patients whose doctors’ offices had the 12-week training program felt more involved in making treatment decisions than patients whose doctors’ offices had the one-hour training.

The three groups didn’t differ in how often patients with asthma went to the emergency room, were admitted to the hospital, or got a steroid prescription.

Who was in the study?

The study included 30 doctors’ offices across North Carolina.

What did the research team do?

The research team assigned each of the doctors’ offices by chance to receive one of the two kinds of training or no training. Then, the team surveyed 1,228 patients with asthma who got care at doctors’ offices that had trainings. Surveys asked patients how involved they felt in decisions about their asthma treatment.

The team also looked at health records for 6,274 patients with Medicaid across all the doctors’ offices. They checked how many times the patients’ asthma led to emergency room visits, hospital stays, or steroid prescriptions.

Patients, caregivers, Medicaid health insurers, and staff from asthma advocacy organizations helped the research team design, plan, and conduct the study.

What were the limits of the study?

A Medicaid asthma program may have helped to improve how often patients had asthma problems in all three groups during this study.

The research team didn’t collect patient surveys at doctors’ offices that didn’t have the trainings. The team doesn’t know how SDM for these patients compared with patients at the offices that had trainings. The team doesn’t know if patients who filled out the surveys had SDM during their doctors’ visits or if patients filled out the surveys more than once.

Future research could look more closely at patients who have SDM during their doctors’ visits to compare the effect of the training programs on these patients’ involvement in decisions.

How can people use the results?

Doctors’ offices can use the results as they consider how to help doctors and their patients with asthma use SDM.

Final Research Report

View this project's final research report.

More to Explore...

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented, and the researchers made changes or provided responses. The comments and responses included the following:

  • Reviewers wondered why the study compared three groups of patients rather than two, that is two intervention arms and a third group of patients that had usual care. The researchers said that the usual care arm allowed them to control for outside factors that could have influenced shared decision making (SDM) in asthma care over the time of the study.
  • Reviewers asked why the researchers did not assess patients’ baseline SDM levels so that the change in SDM within practices could be measured over time. The researchers responded that they measured SDM only at the end of the study since they did not plan to assess changes in SDM over time but instead in comparison to usual care.
  • Reviewers expressed concern about the statistical analyses given the lack of accounting for the possibility of patients completing the anonymous survey more than once, or the possibility of clustering within sites. The researchers acknowledged that they were unable to account for patients completing the survey more than once and that this was a limitation of the study. They did note that they analyzed survey data at the practice level and added some related caveats to the study limitations related to this.
  • Reviewers noted that the report did not discuss the costs of intervention. The researchers said cost analysis wasn’t part of this project. They suspected, however, that there would be significant benefits to improved SDM training because it would lead to improved management of asthma for patients, including reduced emergency visits and hospitalizations. However, future research would be needed to assess the costs and benefits of intervention.
  • Reviewers expressed concern that the results were subject to bias because of clinic practice and demographic differences not accounted for in analyses. For instance, the set of practices with facilitator-led SDM training, which had the greatest change in observed results, also had younger patients, who were more often Caucasian. The researchers said the numbers involved were too low to give them the power to analyze demographic effects. They noted that stratifying by practice size before randomization could have helped them perform more-detailed statistical analyses.

Conflict of Interest Disclosures

Project Information

Hazel Tapp, PhD, BSc
Carolinas Medical Center
Comparing Traditional and Participatory Dissemination of a Shared Decision Making Intervention

Key Dates

May 2013
October 2018

Study Registration Information


Has Results
Award Type
Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Populations Populations PCORI is interested in research that seeks to better understand how different clinical and health system options work for different people. These populations are frequently studied in our portfolio or identified as being of interest by our stakeholders. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: January 25, 2023