Shared decision-making in general practice: an observational study comparing 2007 with 2015.

BACKGROUND Shared decision-making (SDM) is, largely, espoused as the preferred model for making decisions in everyday health care. Studies exploring the application of SDM in primary care practice are still lacking. OBJECTIVES This study explores how GPs involve their patients in decision-making, if application of SDM has increased over time (2007-15), and what factors are associated with it. METHODS We investigated the application of SDM by Dutch GPs by analysing a random set of real-life video-recorded consultations collected in 2007 (n = 50) and 2015 (n = 50). SDM was assessed by observing patient involvement in decision making (OPTION), a reliable and valid instrument measuring the extent to which clinicians involve patients in decision-making by coding 12 behavioural items. In addition, GPs and patients completed questionnaires about their background characteristics. The potential determinants for application of SDM by Dutch GPs (including year of measurement, sex and age of patients and GPs, the nature of complaints, consultation duration and the type of decision discussed) were analysed using multilevel analysis [with patients (Level 1) nested within GPs (Level 2)]. RESULTS In 2015, GPs applied SDM more often compared with 2007 according to OPTION. In consultations with older patients, there is less application of SDM by GPs. CONCLUSIONS Although application of SDM by Dutch GPs has increased, low overall SDM scores still leave room for improvement. GPs should elicit the patient's preferred role in the decision-making process at any time, in particular in consultations with older patients.

[1]  R. Thomson,et al.  Shared Decision Making: A Model for Clinical Practice , 2012, Journal of General Internal Medicine.

[2]  G. Elwyn,et al.  Shared decision making in 2017: International accomplishments in policy, research and implementation. , 2017, Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen.

[3]  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.

[4]  S. van Dulmen,et al.  Discussing patient's lifestyle choices in the consulting room: analysis of GP-patient consultations between 1975 and 2008 , 2010, BMC family practice.

[5]  William M. Tierney,et al.  The effect of discussions about advance directives on patients’ satisfaction with primary care , 2007, Journal of General Internal Medicine.

[6]  A. Stiggelbout,et al.  OPTION(5) versus OPTION(12) instruments to appreciate the extent to which healthcare providers involve patients in decision-making. , 2016, Patient education and counseling.

[7]  M. Weiss,et al.  Measuring shared decision making in the consultation: a comparison of the OPTION and Informed Decision Making instruments. , 2008, Patient education and counseling.

[8]  A. Stiggelbout,et al.  Shared decision making, a buzz-word in the Netherlands, the pace quickens towards nationwide implementation…. , 2017, Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen.

[9]  M. Koopmanschap,et al.  Measuring shared decision making processes in psychiatry: skills versus patient satisfaction. , 2007, Patient education and counseling.

[10]  S. van Dulmen,et al.  Has patients’ involvement in the decision‐making process changed over time? , 2006, Health expectations : an international journal of public participation in health care and health policy.

[11]  France Légaré,et al.  Barriers and facilitators to implementing shared decision-making in clinical practice: update of a systematic review of health professionals' perceptions. , 2008, Patient education and counseling.

[12]  Medically unexplained symptoms: the person, the symptoms and the dialogue , 2017, Family practice.

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

[14]  Glyn Elwyn,et al.  Assessments of the extent to which health‐care providers involve patients in decision making: a systematic review of studies using the OPTION instrument , 2015, Health expectations : an international journal of public participation in health care and health policy.

[15]  A M Stiggelbout,et al.  Shared decision making: Concepts, evidence, and practice. , 2015, Patient education and counseling.

[16]  J. Bensing,et al.  Does training general practitioners result in more shared decision making during consultations? , 2017, Patient education and counseling.

[17]  T Timpka,et al.  In what way may videotapes be used to get significant information about the patient-physician relationship? , 1990, Medical teacher.

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

[19]  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.

[20]  M. O. Olde Rikkert,et al.  Expert and patient consensus on a dynamic model for shared decision-making in frail older patients. , 2016, Patient education and counseling.

[21]  J. Rademakers,et al.  Health literacy in Nederland. , 2018 .

[22]  R. Thomson,et al.  Implementing shared decision making in the NHS: lessons from the MAGIC programme , 2017, British Medical Journal.

[23]  K. Thomas.  The consultation and the therapeutic illusion. , 1978, British medical journal.

[24]  R. Epstein,et al.  Patient preferences and healthcare outcomes: an ecological perspective , 2012, Expert review of pharmacoeconomics & outcomes research.

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

[26]  S. van Dulmen,et al.  Consulting room computers and their effect on general practitioner-patient communication. , 2010, Family practice.

[27]  R. Grol,et al.  Familiarity with a GP and patients' evaluations of care. A cross-sectional study. , 2004, Family practice.

[28]  J. Bensing,et al.  Monitoring health inequalities through general practice: the Second Dutch National Survey of General Practice. , 2005, European journal of public health.

[29]  G. Elwyn,et al.  The OPTION scale: measuring the extent that clinicians involve patients in decision‐making tasks , 2005, Health expectations : an international journal of public participation in health care and health policy.

[30]  F. Légaré,et al.  An interprofessional approach to shared decision making: an exploratory case study with family caregivers of one IP home care team , 2014, BMC Geriatrics.

[31]  France Légaré,et al.  Decision aids for people facing health treatment or screening decisions. , 2017, The Cochrane database of systematic reviews.

[32]  J. Gérvas,et al.  [Primary care in Europe]. , 1993, Atencion primaria.

[33]  William Verheul,et al.  Shifts in doctor-patient communication between 1986 and 2002: a study of videotaped General Practice consultations with hypertension patients , 2006, BMC family practice.

[34]  Richard L Street,et al.  Participatory patient-physician communication and morbidity in patients with systemic lupus erythematosus. , 2003, Arthritis and rheumatism.

[35]  G. Elwyn,et al.  Impact of age, health locus of control and psychological co-morbidity on patients' preferences for shared decision making in general practice. , 2006, Patient education and counseling.

[36]  S. van Dulmen,et al.  Sharing decisions during diagnostic consultations; an observational study in pediatric oncology. , 2016, Patient education and counseling.

[37]  L P Noldus,et al.  The Observer Video-Pro: New software for the collection, management, and presentation of time-structured data from videotapes and digital media files , 2000, Behavior research methods, instruments, & computers : a journal of the Psychonomic Society, Inc.

[38]  G. Elwyn,et al.  Shared decision making: really putting patients at the centre of healthcare , 2012, BMJ : British Medical Journal.

[39]  A. Viera,et al.  Understanding interobserver agreement: the kappa statistic. , 2005, Family medicine.

[40]  G. Elwyn,et al.  Shared decision making: developing the OPTION scale for measuring patient involvement , 2003, Quality & safety in health care.