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Patient Educ Couns. 2017 Sep;100(9):1701-1708. doi: 10.1016/j.pec.2017.05.002. Epub 2017 May 2.

Clinical trainees' responses to parents who question evidence-based recommendations.

Author information

1
Division of Public Health Sciences, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
2
Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada; Office of Education and Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada; Research Centre, CHU de Québec-Université Laval, Quebec City, Quebec, Canada.
3
Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA.
4
Research Centre, CHU de Québec-Université Laval, Quebec City, Quebec, Canada.
5
Division of Public Health Sciences, Washington University in St. Louis School of Medicine, St. Louis, MO, USA. Electronic address: mpoliti@wustl.edu.

Abstract

OBJECTIVE:

We examined clinicians' attitudes, beliefs, and behavioral intentions about discussing evidence and eliciting values when patients question recommendations.

METHODS:

We randomized trainees to read one of three scenarios about a parent of a one-year-old: 1) overuse (parent requests antibiotics for presumed viral infection); 2) equipoise (tubes for recurrent ear infections); 3) underuse (parent hesitates about vaccination). Participants then answered survey questions. Outcomes included time spent clarifying values (primary), attitudes and beliefs about the parent (secondary).

RESULTS:

132 medical students and pediatric residents enrolled; 119 (90%) completed the study. There were no differences in time participants would spend clarifying values (antibiotics 26±12%; equipoise 28±11%; vaccine-hesitancy 22±11%; p=0.058). Participants in the vaccine-hesitancy group (vs. other groups) would spend less time answering questions (p=0.006). Participants in the antibiotics (vs. equipoise) group perceived the parent as difficult (p=0.0002). Those in the vaccine-hesitancy group (vs. other groups) perceived the parent as difficult, saw less value in the conversation, and had lower respect for the parent's views (all ps<0.0001). Most (76%) wanted additional training navigating these discussions.

CONCLUSION:

Clinicians' attitudes may impact conversations when patients question evidence-based recommendations.

PRACTICE IMPLICATIONS:

Clinicians should consider ways to discuss evidence and clarify patients' values to optimize health without damaging patient-clinician relationships.

KEYWORDS:

Doctor-patient relationship; Evidence-based medicine; Health communication

PMID:
28495389
DOI:
10.1016/j.pec.2017.05.002
[Indexed for MEDLINE]

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