General practitioners minimally involve their patients in shared-decision making
Shared decision-making in general practice: an observational study comparing 2007 with 2015Meijers MC, Noordman J, Spreeuwenberga P et al. - Family Practice, 2018, 1–8 doi:10.1093/fampra/cmy070
Introduction and methods
Shared decision-making (SDM) is highly accepted as the preferred model for making decisions in everyday health care [1,2]. In this process professionals and patients share knowledge, values and preferences for different options for therapy, or not, complaints and diseases, with evidence-based information about options, outcomes and uncertainties . SDM helps patients to consider their options , improve their biomedical and psychosocial health outcomes [5-7], and increase their knowledge, trust  and ownership of their health . Moreover, it also has economic benefits by reducing overuse of unwarranted therapies while increasing choices for therapies associated with a net benefit .
Although SDM preferably starts as early as the diagnostic phase of the first consultation , which in particular concerns primary care consultations, research on SDM mainly focuses on secondary prevention or on a specific disease and its treatment options .Therefore this study aimed to explore how general practitioners (GPs) involve their patients in SDM, if this involvement has increased from 2007 to 2015, and what factors are associated with it.
This observational study explored if and how Dutch GPs apply SDM in primary care consultations by observing real-life video-reordered consultations collected in 2007 (n=50) and 2015 (n=50), including patients (aged ≥18 years) who spoke and wrote sufficient Dutch, with single new disease episode or single new complaint. SDM behavior was measured by using the observing patient involvement in decision making (OPTION ) instrument, by coding on a 5-point Likert scale (the higher of score the higher level of SDM behavior) for individual items. Both patient and GP filled in questionnaires to obtain information on background characteristics. Patient’s main complaint during consultation were registered according to the International Classification of Primary Care (ICPS) and type of decision was registered using categories: medical prescription, referral, watchful waiting, further investigation and surgical intervention. In addition, duration of consultation was registered.
- The GPs in 2007 (n=29) were significantly older (mean age 51.6 years) than those in 2015 (n=17) (mean age 45.5 years).
- In both 2007 and 2015 the most common decision made during consultation was a medical prescription.
- Consultation was significantly longer in 2015 (mean duration 11.28 minutes) than in 2007 (mean duration 9.24 minutes).
- The mean SDM score was significantly higher in 2015 (mean OPTION score 22.6) than in 2007 (mean OPTION score 14.1).
- In 2007 the majority of the scores revealed that ‘the behavior towards SDM was not observed at all’. In 2005 the majority of the scores revealed that ‘minimal attempt was made to exhibit the behavior’.
- In both 2007 and 2015 the predominantly observed items were ‘identifying problem(s)’ and ‘indicating a need to review the decision’. Least observed items were ‘assessing preferred approach’ and ‘eliciting preferred involvement’.
Factors associated with SDM
- GPs applied SDM more often in 2015 compared with 2007, according to OPTION.
- After multivariable analysis, patient’s age showed an significant effect on application of SDM (-0.12, 95%CI: -0.23 to -0.014) with less SDM observed in older patients.
This observational study showed that in 2015 consultations were significantly longer compared with 2007, and slightly more SDM behavior was applied by GPs during daily practice in 2015. However, only a minimal attempt was made towards SDM behavior, with ‘drawing attention to an identified problem as one that requires a decision-making process’ and ‘indicating the need to review the decision’ as most predominant observed items. In older patients, less SDM behavior was observed during consultation.