General practitioners' views on shared decision making: a qualitative analysis.

Despite rhetoric about increasing partnership in the consultation, shared decision making (SDM) is not necessarily happening in practice. As patient involvement in decision making cannot be achieved without general practitioners' (GPs) co-operation, attention to their concerns is essential. Previous research has used simulated patients to explore this area. Here, data from consultations and interviews with patients and GPs were used in focus group discussions enabling GPs to ground their views of the practical application of SDM in their own and other participants' real life practice. The following ideas were discussed; what constitutes SDM in practice, negotiation about treatment, perceptions of patients' viewpoints and perceived barriers to SDM. Agreement with SDM in theory may not translate into practice. The process outlined is being developed in order to establish whether the techniques could provide a supportive environment in which GPs can make changes to their practice to increase patient participation.

[1]  Cathy Charles,et al.  How to improve communication between doctors and patients , 2000, BMJ : British Medical Journal.

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

[3]  B Chewning,et al.  Medication decision-making and management: a client-centered model. , 1996, Social science & medicine.

[4]  J. Thistlethwaite.  Making and sharing decisions about management with patients: the views and experiences of pre‐registration house officers in general practice and hospital , 2002, Medical education.

[5]  V. Entwistle,et al.  Evaluating Interventions to Promote Patient Involvement in Decision-Making: By What Criteria Should Effectiveness be Judged? , 1998, Journal of health services research & policy.

[6]  C P Bradley,et al.  Misunderstandings in prescribing decisions in general practice: qualitative study , 2000, BMJ : British Medical Journal.

[7]  N. Britten,et al.  Qualitative methods and prescribing research. , 2000 .

[8]  C P Bradley,et al.  Doctor-patient communication about drugs: the evidence for shared decision making. , 2000, Social science & medicine.

[9]  S. Kaplan,et al.  Expanding patient involvement in care. Effects on patient outcomes. , 1985, Annals of internal medicine.

[10]  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.

[11]  B. McKinstry.  Do patients wish to be involved in decision making in the consultation? A cross sectional survey with video vignettes , 2000, BMJ : British Medical Journal.

[12]  A Coulter,et al.  Partnerships with Patients: The Pros and Cons of Shared Clinical Decision-Making , 1997, Journal of health services research & policy.

[13]  G. Elwyn,et al.  Towards a feasible model for shared decision making: focus group study with general practice registrars , 1999, BMJ.

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

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

[16]  C P Bradley,et al.  Patients' unvoiced agendas in general practice consultations: qualitative study , 2000, BMJ : British Medical Journal.

[17]  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.

[18]  N. Britten,et al.  Misunderstandings in general practice prescribing decisions: a qualitative study , 2000 .

[19]  R Jones,et al.  Does continuing medical education in general practice make a difference? , 1999, BMJ.