Does training general practitioners result in more shared decision making during consultations? |
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| Institution: | 1. Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Mailbox 85500, 3508 GA Utrecht, The Netherlands;2. NIVEL (Netherlands Institute for Health Services Research), Mailbox 1568, 3500 BN Utrecht, The Netherlands;3. Faculty of Social and Behavioural Science, Utrecht University, Postbus 80140, 3508 TC Utrecht, The Netherlands;4. Groningen University, University Medical Centre Groningen, Dept. of General Practice Groningen A. Deusinglaan 1, 9712 CP Groningen, The Netherlands;1. School of Public Health, The University of Hong Kong, Hong Kong;2. The Breast Centre, Department of Surgery, Kwong Wah Hospital, Hong Kong;3. Breast Surgery Division, Department of Surgery, The University of Hong Kong, Hong Kong;1. Evaluation Unit of the Canary Islands Health Service (SESCS), Tenerife, Spain;2. Health Services Research on Chronic Patients Network (REDISSEC), Spain;3. Center for Biomedical Research of the Canary Islands (CIBICAN), Tenerife, Spain;4. Canarian Islands Foundation of Health Research (FUNCANIS), Tenerife, Spain;5. Division of Endocrinology and Nutrition, Insular University Hospital, Las Palmas de Gran Canaria, Spain;6. Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA;7. Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA;1. Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands;2. Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands;3. School CAPHRI, Department of Family Medicine, Maastricht University, Maastricht, The Netherlands;4. Department of Obstetrics & Gynaecology, Radboudumc University Medical Center, Nijmegen, The Netherlands;1. The Research Center, Akershus University Hospital, Lorenskog, Norway;2. Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway;3. Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway;4. Indiana University School of Medicine, VA HSR&D Center of Excellence, Roudebush VA Medical Center, Indianapolis, USA;5. Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lorenskog, Norway |
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| Abstract: | ObjectiveWe conducted a clustered randomised controlled trial to study the effects of shared decision making (SDM) on patient recovery. This study aims to determine whether GPs trained in SDM and reinforcing patients’ treatment expectations showed more trained behaviour during their consultations than untrained GPs.MethodsWe compared 86 consultations conducted by 23 trained GPs with 89 consultations completed by 19 untrained GPs. The primary outcomes were SDM, as measured by the OPTION scale, and positive reinforcement, as measured by global observation. Secondary outcomes were the level of autonomy in decision making and the duration of the consultation.ResultsIntervention consultations scored significantly higher on most elements of the OPTION scale, and on the autonomy scale; however, they were three minutes longer in duration, and the mean OPTION score of the intervention group remained below average.ConclusionTraining GPs resulted in more SDM behaviour and more autonomy for the patient; however, this increase is not attributable to the adoption of a patient perspective. Furthermore, while we aimed to demonstrate that SDM facilitates the reinforcement of patients’ positive expectations, the measurement of this behaviour was not reliable.Practice implicationsIn supporting SDM, professionals should give greater attention to patients’ treatment expectations. |
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| Keywords: | Patient participation Primary health care Medical education Shared decision-making Patient-oriented outcomes |
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