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J Eval Clin Pract. 2018 Feb;24(1):56-64. doi: 10.1111/jep.12665. Epub 2016 Nov 16.

On a learning curve for shared decision making: Interviews with clinicians using the knee osteoarthritis Option Grid.

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The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA.
Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.
Pennine MSK Partnership Ltd, Integrated Care Centre, Oldham, UK.



Tools used in clinical encounters to illustrate to patients the risks and benefits of treatment options have been shown to increase shared decision making. However, we do not have good information about how these tools are viewed by clinicians and how clinicians think patients would react to their use.


Our aim was to examine clinicians' views about the possible and actual use of tools designed to support patients and clinicians to collaborate and deliberate about treatment options, namely, Option Grid decision aids.


We conducted a thematic analysis of qualitative interviews embedded in the intervention phase of a trial of an Option Grid decision aid for osteoarthritis of the knee. Interviews were conducted with 6 participating clinicians before they used the tool and again after clinicians had used the tool with 6 patients.


In the first interview, clinicians voiced concerns that the tool would lead to an increase in encounter duration, patient resistance regarding involvement in decision making, and potential information overload. At the second interview, after minimal training, the clinicians reported that the tool had changed their usual way of communicating, and it was generally acceptable and helpful to integrate it into practice.


After experiencing the use of Option Grids, clinicians became more willing to use the tools in their clinical encounters with patients. How best to introduce Option Grids to clinicians and adopt their use into practice will need careful consideration of context, workflow, and clinical pathways.


arthritis; clinician-patient communication; patient decision aids; qualitative research; shared decision making

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