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Can Fam Physician. 2019 Feb;65(2):e64-e75.

How often do both core competencies of shared decision making occur in family medicine teaching clinics?

Author information

1
Clinical research coordinator at the Jewish General Hospital in Montreal, Que.
2
Research associate in the Research Unit of the Office of Education and Professional Development at Laval University in Quebec city, Que.
3
Doctoral student in psychology at Laval University.
4
Biostatistician in the Clinical Research Platform of the Research Centre of the CHU de Québec in Quebec city.
5
Practising family physician and Full Professor in the Department of Family and Emergency Medicine at Laval University, Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Scientific Co-director of the Canadian Cochrane Network Site at Laval University, and a researcher at the Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL).
6
Professor in the Department of Family and Emergency Medicine and a researcher in the Office of Education and Professional Development in the Faculty of Medicine at Laval University.
7
Medical student in the Faculty of Medicine at Laval University.
8
Resident in the Faculty of Medicine at Laval University.
9
Consultant with the Pan American Health Organization and the World Health Organization in Washington, DC.
10
Oncologist in the Division of Radiation Oncology in the Department of Medicine at the CHU de Québec-Laval University.
11
Family physician in the Herzl Family Practice Centre in Montreal, and Associate Professor in the Department of Family Medicine and Director of the Clinician Scholar Program in the Department of Family Medicine at McGill University in Montreal.
12
Associate Professor in the Department of Family and Emergency Medicine and a researcher in the Office of Education and Professional Development at Laval University, the Centre d'excellence sur le vieillissement de Québec at the Research Centre of the CHU de Québec, and the CERSSPL-UL.
13
Associate Professor in the Department of Family and Emergency Medicine and a researcher in the Office of Education and Professional Development at Laval University, Population Health and Optimal Health Practices at the Research Centre of the CHU de Québec, the Ottawa Hospital Research Institute in Ontario, and the CERSSPL-UL. holly.witteman@fmed.ulaval.ca.

Abstract

OBJECTIVE:

To assess how often risk communication and values clarification occur in routine family medicine practice and to explore factors associated with their occurrence.

DESIGN:

Qualitative and quantitative cross-sectional study.

SETTING:

Five university-affiliated family medicine teaching clinics across Quebec.

PARTICIPANTS:

Seventy-one health professionals (55% physicians, 35% residents, 10% nurses or dietitians) and 238 patients (76% women; age range 16 to 82 years old).

MAIN OUTCOME MEASURES:

The presence or absence of risk communication and values clarification during visits in which decisions were made was determined. Factors associated with the primary outcome (both competencies together) were identified. The OPTION5 (observing patient involvement in decision making) instrument was used to validate the dichotomous outcome.

RESULTS:

The presence of risk communication and values clarification during visits was associated with OPTION5 scores (area under the curve of 0.80, 95% CI 0.75 to 0.86, P < .001). Both core competencies of shared decision making occurred in 150 of 238 (63%) visits (95% CI 54% to 70%). Such an occurrence was more likely when the visit included discussion about beginning something new, treatment options, or postponing a decision, as well as when health professionals preferred a collaborative decision-making style and when the visit included more decisions or was longer. Alone, risk communication occurred in 203 of 238 (85%) visits (95% CI 82% to 96%) and values clarification in 162 of 238 (68%) visits (95% CI 61% to 75%).

CONCLUSION:

Health professionals in family medicine are making an effort to engage patients in shared decision making in routine daily practice, especially when there is time to do so. The greatest potential for improvement might lie in values clarification; that is, discussing what matters to patients and families.

PMID:
30765371
PMCID:
PMC6515489

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