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J Clin Epidemiol. 2019 Apr;108:132-139. doi: 10.1016/j.jclinepi.2018.11.027. Epub 2018 Dec 7.

The actor-partner interdependence model in shared decision-making: an illustrative example of its application to the physician-patient dyad in primary care consultations.

Author information

1
Centre intégré en santé et services sociaux de Chaudière-Appalaches, Hôtel-Dieu de Lévis, 143, rue Wolfe, Lévis, Quebec G6V 3Z1, Canada.
2
Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Pavillon Landry-Poulin, 2525, chemin de la Canardière, Quebec, Quebec G1J 0A4, Canada.
3
Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Pavillon Landry-Poulin, 2525, chemin de la Canardière, Quebec, Quebec G1J 0A4, Canada; Department of Family and Emergency Medicine, Université Laval, 1050 Avenue de la Médecine, Quebec City, Quebec G1V 0A6, Canada. Electronic address: France.legare@mfa.ulaval.ca.

Abstract

OBJECTIVES:

We applied the actor-partner interdependence model, a method used to evaluate the relationship process between two related persons, to patient-physician data about the effect of shared decision-making behaviors on patient and physician uncertainty. We discuss measurement and interpretation problems.

STUDY DESIGN AND SETTING:

The EXACKTE2 project was a cross-sectional study of 263 unique patient-physician dyads in 17 primary care clinics in Canada. Participants independently completed self-administered questionnaires postconsultation to measure patients' and physicians' perceptions of shared decision-making behaviors and their uncertainty about whether the decision was the best one for the patient. We used the actor-partner interdependence model to explore the effect of shared decision-making behaviors on patient and physician uncertainty.

RESULTS:

Application of the actor-partner interdependence model to our data showed significant actor effects only. Our exploratory analysis suggested that an appropriate dyadic pattern for this context would be the couple-oriented model.

CONCLUSION:

Each actor's perception of the physicians' shared decision-making behaviors appeared only to affect their own uncertainty (actor effects), but the questionnaire may have been inadequate for identifying partner effects. Researchers should further explore using the actor-partner interdependence model to analyze actor-partner interdependence in the physician-patient relationship, and format questions tailored precisely to the model.

KEYWORDS:

Actor–partner interdependence model; Dyadic measures; Measurement problem; Patient–physician dyad; Shared decision-making; Uncertainty

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