What are the ingredients for a successful evidence-based patient choice consultation?: A qualitative study.

The evidence-based patient choice (EBPC) approach is one of a number of newly emerging templates for medical encounters that advocate evidence-informed choice and shared decision-making. These models emphasise respect for patient preferences for involvement in health care decisions and advocate the sharing of good quality evidence-based information. In the medical consultation EBPC involves providing patients with evidence-based information in a way that facilitates their ability to make choices or decisions about their health care. Whereas the key principles of shared decision-making have been conceptualised, so far, no qualitative investigations have been undertaken to establish the key components of an EBPC consultation. Therefore, a series of semi-structured interviews were carried out with key informants to identify the elements and skills required for a successful EBPC consultation to occur. The interviews were conducted with purposively selected UK general practitioners (n=11), hospital doctors (n=10), practice nurses (n=5), academics (n=11) and lay people (n=8). Qualitative analysis of participants' responses was conducted using the constant comparative method. Six main themes emerged from the data, these were research evidence/medical information, the doctor-patient relationship, patient perspectives, decision-making processes, time issues and establishing the patient's problem. All respondents placed importance on doctors and patients being well informed and appraised of the latest available medical evidence. There was a general view that evidence-based information regarding diagnosis and treatment options should be shared with patients during a consultation. However, there were no suggestions as to how this might be achieved in practice. Participants' opinions relating to which model of decision-making should be adopted ranged from favouring an informed choice model, to the view that decision-making should be shared equally. Similarly, there was no clear view on how much guidance a doctor should offer a patient during decision-making concerning the most appropriate treatment option for that patient.

[1]  T Fahey,et al.  The impact of patients' preferences on the treatment of atrial fibrillation: observational study of patient based decision analysis. , 2000, BMJ : British Medical Journal.

[2]  K C Carriere,et al.  Information needs and decisional preferences in women with breast cancer. , 1997, JAMA.

[3]  Jenny Field,et al.  General practitioners' perceptions of the route to evidence based medicine: a questionnaire survey , 1998, BMJ.

[4]  D. Sackett.  Evidence-Based Medicine: How to Practice and Teach EBM , 2018 .

[5]  J. Saul,et al.  Information needs of patients with cancer: results from a large study in UK cancer centres , 2001, British Journal of Cancer.

[6]  R. Gross,et al.  The influence of patient-practitioner agreement on outcome of care. , 1981, American journal of public health.

[7]  Simon de Lusignan,et al.  National electronic Library for Health (NeLH) , 1999, BMJ.

[8]  A. Edwards,et al.  Evidence-based medicine and general practice. , 1997, The British journal of general practice : the journal of the Royal College of General Practitioners.

[9]  E. Emanuel,et al.  Four models of the physician-patient relationship. , 1992, JAMA.

[10]  S. Buetow,et al.  Evidence-based medicine: the need for a new definition. , 2000, Journal of evaluation in clinical practice.

[11]  H. Brody,et al.  Physician Recommendations and Patient Autonomy: Finding a Balance between Physician Power and Patient Choice , 1996, Annals of Internal Medicine.

[12]  P Maguire,et al.  Psychological effects of being offered choice of surgery for breast cancer , 1994, BMJ.

[13]  K. Luker,et al.  Decision‐making role preferences and information needs: a comparison of colorectal and breast cancer , 1999, Health expectations : an international journal of public participation in health care and health policy.

[14]  P. Zvára,et al.  The Internet and patient education--resources and their reliability: focus on a select urologic topic. , 1999, Urology.

[15]  D. Lupton.  Consumerism, reflexivity and the medical encounter. , 1997, Social science & medicine.

[16]  Jonathan Silverman,et al.  Skills for Communicating with Patients , 1998 .

[17]  L. Fallowfield,et al.  Teaching senior oncologists communication skills: results from phase I of a comprehensive longitudinal program in the United Kingdom. , 1998, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[18]  J. Mayer,et al.  The attitudes of Australian GPs to evidence-based medicine: a focus group study. , 1999, Family practice.

[19]  A. Beisecker,et al.  Patient Information-Seeking Behaviors When Communicating With Doctors , 1990, Medical care.

[20]  Amiram Gafni,et al.  Shared decision-making in the medical encounter , 1994 .

[21]  I. Janis.  Counseling on personal decisions : theory and research on short-term helping relationships , 1982 .

[22]  W. Levinson,et al.  Informed decision making in outpatient practice: time to get back to basics. , 1999, JAMA.

[23]  J. Sloan,et al.  Decision making during serious illness: what role do patients really want to play? , 1992, Journal of clinical epidemiology.

[24]  G. Elwyn,et al.  Shared decision-making in primary care: the neglected second half of the consultation. , 1999, The British journal of general practice : the journal of the Royal College of General Practitioners.

[25]  C W Oliver,et al.  The quality of surgical information on the Internet. , 1999, Journal of the Royal College of Surgeons of Edinburgh.

[26]  W Godolphin,et al.  Framework for teaching and learning informed shared decision making. , 1999, BMJ.

[27]  Gerald Dworkin,et al.  The theory and practice of autonomy , 1992 .

[28]  J. Dixon,et al.  The NHS plan , 2000, BMJ : British Medical Journal.

[29]  P. Maguire.  Can communication skills be taught? , 1990, British journal of hospital medicine.

[30]  S. Buetow Ma PhD and,et al.  Evidence-based medicine: the need for a new definition , 2001 .

[31]  Glyn Elwyn,et al.  General practice registrar responses to the use of different risk communication tools in simulated consultations: a focus group study , 1999, BMJ.

[32]  E H Wagner,et al.  The Effect of a Shared Decisionmaking Program on Rates of Surgery for Benign Prostatic Hyperplasia Pilot Results , 1995, Medical Care.

[33]  H. Brody.  Autonomy Revisited: Progress in Medical Ethics: Discussion Paper , 1985, Journal of the Royal Society of Medicine.

[34]  R. Frankel,et al.  The effect of physician behavior on the collection of data. , 1984, Annals of internal medicine.

[35]  R. Deber,et al.  Physicians in health care management: 7. The patient-physician partnership: changing roles and the desire for information. , 1994, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[36]  M Baum,et al.  Psychological outcomes of different treatment policies in women with early breast cancer outside a clinical trial. , 1990, BMJ.

[37]  H. Brody.  Autonomy revisited: progress in medical ethics. , 1986, World medical journal.

[38]  B. Lo,et al.  Do patients want to participate in medical decision making? , 1984, JAMA.

[39]  T A Sheldon,et al.  Evidence-Informed Patient Choice: Practical Issues of Involving Patients in Decisions About Health Care Technologies , 1998, International Journal of Technology Assessment in Health Care.

[40]  R. Deber,et al.  Physicians in health care management: 8. The patient-physician partnership: decision making, problem solving and the desire to participate. , 1994, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[41]  P. Maguire,et al.  Workshops for consultants on the teaching of clinical communication skills , 1993, Medical education.

[42]  Richard Savage,et al.  Effect of a general practitioner's consulting style on patients' satisfaction: a controlled study. , 1990, BMJ.

[43]  D. Heaney,et al.  Measuring quality in general practice. Pilot study of a needs, process and outcome measure. , 1997, Occasional paper.

[44]  M. Stewart.  Effective physician-patient communication and health outcomes: a review. , 1995, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[45]  A. Grubb,et al.  Why Britain can't afford informed consent. , 1985, The Hastings Center report.

[46]  Amiram Gafni,et al.  Decision-making in the physician-patient encounter , 1998 .

[47]  Tony Hope,et al.  Barriers to the evidence-based patient choice (EBPC) consultation. , 2002, Patient education and counseling.

[48]  E. Guadagnoli,et al.  Patient participation in decision-making. , 1998, Social science & medicine.

[49]  Vikki Entwistle,et al.  Informing patients: an assessment of the quality of patient information materials Informing patients: an assessment of the quality of patient information materials Coulter Angela Entwisde Vikki Gilbert David King's Fund 219pp £16.95 1-85717-2144-0 18571721440. , 1999, Nursing Standard.

[50]  J. Bensing,et al.  Bridging the gap. The separate worlds of evidence-based medicine and patient-centered medicine. , 2000, Patient education and counseling.

[51]  Tony Hope,et al.  Evidence-based patient choice , 1999, Evidence Based Medicine.

[52]  C. Charles,et al.  Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). , 1997, Social science & medicine.

[53]  Ann Louise Kinmonth,et al.  General practice Randomised controlled trial of patient centred care of diabetes in general practice : impact on current wellbeing and future disease risk , 1998 .

[54]  D. Brody,et al.  The patient's role in clinical decision-making. , 1980, Annals of internal medicine.

[55]  D. Roter.  Physician/patient communication: transmission of information and patient effects. , 1983, Maryland state medical journal.

[56]  F. Davidoff,et al.  Patient-Centered Medicine: A Professional Evolution , 1996 .

[57]  P. Symonds,et al.  Information needs of cancer patients in west Scotland: cross sectional survey of patients' views , 1996, BMJ.

[58]  Renée A. Irvin,et al.  Citizen Participation in Decision Making: Is It Worth the effort? , 2004 .

[59]  C. Charles,et al.  Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model. , 1999, Social science & medicine.

[60]  Judith Green,et al.  Commentary: grounded theory and the constant comparative method. , 1998, BMJ.

[61]  D Charnock,et al.  Helping patients access high quality health information , 1999, BMJ.

[62]  M. Calnan,et al.  Patients' action during their cardiac event: qualitative study exploring differences and modifiable factors , 1998, BMJ.

[63]  M. Barry,et al.  Patient Reactions to a Program Designed to Facilitate Patient Participation in Treatment Decisions for Benign Prostatic Hyperplasia , 1995, Medical care.

[64]  G. Dickie,et al.  The physician's actions and the outcome of illness in family practice. , 1986, The Journal of family practice.

[65]  J. Sloan,et al.  Treatment decision making in women newly diagnosed with breast cancer. , 1996, Cancer nursing.

[66]  S. Reiser,et al.  The era of the patient. Using the experience of illness in shaping the missions of health care. , 1993, JAMA.

[67]  P Kinnersley,et al.  Shared decision making and the concept of equipoise: the competences of involving patients in healthcare choices. , 2000, The British journal of general practice : the journal of the Royal College of General Practitioners.