A paper has been published in Health Expectations looking at the extent to which healthcare providers involve patients in the decision-making process during consultations.
Researchers from Quebec systematically reviewed studies that used the OPTION instrument (Observing Patient Involvement in Decision Making) across a range of clinical contexts, including different health professions and lengths of consultation.
The researchers identified that little is known about the extent to which healthcare providers facilitate patient involvement during routine clinical consultations and what behaviours could improve the situation.
Similarly, little is known about how the clinician’s effort to involve patients in decision making varies depending on the clinical context, such as profession, the medical condition addressed or the length of consultation
33 eligible studies were identified and included in the study. Generally, without interventions to implement SDM, most healthcare providers did not demonstrate that they were attempting to involve their patients with consistency. After interventions, ie training to support SDM, however, some studies displayed significant improvements of OPTION scores.
The study also found that patient involvement does not depend solely on the health-care providers’ competencies, because introducing decision aids or assigning pre-scripted questions for patients to ask during consultations nearly always improved the health-care providers’ overall demonstration of patient-involving behaviours.
The three most consistently observed SDM-related behaviours by the healthcare providers were that the clinician: drew attention to an identified problem as one that requires a decision making process; provided opportunities for questions; and indicated the need to review or defer the decision.
The analysis finds behaviours that required tailoring care to patient preferences were particularly lacking. The three least consistently observed behaviours were: asking patients their preferred level of involvement in decision making; assessing a patient’s preferred approach to receiving information to assist their decision making (e.g. discussion, printed material, graphical data, video or other media); and explaining that there is more than one way approach to dealing with a problem (‘equipoise’).
Patient involving behaviours were found to be performed more consistently in studies with lengthier consultations.
You can access the full paper here.
Couët, N., Desroches, S., Robitaille, H., Vaillancourt, H., Leblanc, A., Turcotte, S., Elwyn, G. and Légaré, F. (2015), Assessments of the extent to which health-care providers involve patients in decision making: a systematic review of studies using the OPTION instrument. Health Expectations, 18: 542–561. doi: 10.1111/hex.12054