Haskard 2008.

Methods	Randomization procedure: Adequate. Physicians were randomized into one of four groups in a fully crossed 2 x 2 between‐subjects analysis of variance (ANOVA) design assigned by a computer generated random order Informed consent obtained: Yes Protection against contamination: Not Used Outcomes assessors blinded: Unclear. Two groups of raters rated 2000 audio tapes from all three time points and rating were z‐scored within rater to equate individual variability in use of the rating scale but blinding of raters was not mentioned Intention to treat analysis: Not stated as used Potential for unit of analysis error: Yes, acknowledged and adjusted. They randomized by physician and some measures are from patients who were different groups of patients at different times but this was corrected for with ANOVA design Comments on study quality: They used 156 physicians in order to provide adequate power with a robust and generalisable random‐effects model
Participants	Profession: Medicine Specialty: Primary care, Obstetrics/genecology, family medicine, internal medicine Years experience: Mean 11.6 years, SD  10.0 years Clinical setting: University medical centres, Department of Veterans Affairs clinic, Staff model HMO Level of Care: Primary Country: United States Health problem/Type of Patient: Counseling about weight loss, exercise, quitting smoking, and alcohol
Interventions	Aim of study (hypothesis): The physician training and patient training will each improve information exchange, health behavior counselling, and patient and physician satisfaction with the visit Delayed until 6‐month follow‐up for supervised sessions to facilitated consolidation of training with practice (Expected Outcome): The patient training will show positive effects on physician satisfaction and attitudes, although these effects will be weaker than those of physician training (because patients were not followed over time, and their training was relatively brief). Outcomes will be worse from training only one member of the dyad compared with training both or no training for physician and patient Content of intervention: Part I:First month. 6‐hr interactive workshop on core communication skills in healthcare teaching engaging, empathizing, educating patients about diagnosis, prognosis, and treatment and enlisting patients in mutually agreed upon treatment plans Second month: 6‐hr interactive workshop on patient adherence, enhancing patients’ health lifestyles, reducing health risk behaviours, and building confidence and conviction in patients to make health behavior changes Third month: 6‐hr interactive workshop on sources and nature of interpersonal difficulties between providers and patients, recognizing and assessing tension in relationships, acknowledging problems, discovering meaning, showing compassion, setting boundaries, and helping patients find additional support. Includes key provider‐patient communication competencies detailed in Kalamazoo Consensus statement Part II Coaching sessions (30‐45 min) Review of a routine audio‐taped patient visit, and additional tapes on communicating with terminally ill patients, informed consent, health beliefs, improving adherence, and working with patients with alcohol and nicotine dependence Review of an audio‐taped patient visit involving the issue of patient behavior change and received a copy of Motivational Interviewing (Miller & Rollnick, 1991) Review of a difficult interaction audio‐taped patient visit and receiving a copy of Conversation Repair (Platt, 1995) Patient training 20‐min waiting room pre‐visit intervention involved listening to audio CD with accompanying patient guide book focusing on planning and organizing concerns and questions for physician and encouragement to discuss treatment choices, negotiate best plan, repeat their understanding of the plan, follow‐up of care with their physician, asking questions about medications, tests, procedures, and referral Conceptual Focus: Shared decision making & motivational interviewing. Sharing decisions about interventions. Sharing the management of the health problems with the patient. Interactional skills Doctor patient relationship/Interviewing skills.  Number of providers receiving intervention: start group 1 = 31/156, group 1a = 35/156 end group 1 = 27/127, group 1a = 34/127. (Groups 1b & 2 did not receive the provider intervention but group 1b patients received the patient intervention) Number of patient receiving intervention: total number of patients = 2196 no data on patients per group Fidelity/integrity of intervention: Appointments with doctors and patients were audio‐taped
Outcomes	(They only reported significant results)  Primary Outcomes: Patient satisfaction (when physician trained and not trained)Physician satisfaction with patient (when patient trained and not trained); as measured by patient and physician satisfaction surveys Consultation process: Physician information giving, satisfaction with consultation and sensitive communication, whether physician conducted a detailed physical examination. Satisfaction: Rating on Physician Information‐giving scale (Heisler), single item: whether recommend doctor to a friend Health behaviours: NA Health status: NA
Notes	Also collected Provider Outcomes: 1. Physician Satisfaction with patient. 2. Physician wanted aspects of the physician‐patient relationship to change. (questionnaires & audiotape ratings)
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Used computer generated random order
Allocation concealment (selection bias)	Unclear risk	Article does not state that randomisation was concealed
Blinding (performance bias and detection bias) All outcomes	Unclear risk	Two groups of raters rated 2000 audio tapes from all three time points and ratings were z‐scored within rater to equate individual variability in use of the rating scale but blinding of raters was not mentioned. Physicians were aware of which patients would receive training
Incomplete outcome data (attrition bias) All outcomes	High risk	Had attrition rate of 29/156 (18.6%) of total randomized sample; control, physician only trained, and patient only trained had similar rates; but group with both physicians and patients trained had attrition rate of 29%. Did not use ITT analysis
Selective reporting (reporting bias)	High risk	Looked at numerous outcomes and reported only results that were statistically significant. "Bordeline significant items (P < 0.10) were available in an Appendix held by authors. Did not indicate that results had been adjusted for multiple comparisons
Other bias	High risk	Unclear whether protected against contamination, but not likely. Acknowledged and adjusted for unit of analysis error with design and in analysis. Collected baseline, but did not provide information on results or indicated that they adjusted for these differences