Evaluation of the quality of patient information to support informed shared decision-making

Abstract

Objectives: (a) To find out how much patient information material on display in family physicians' offices refers to management choices, and hence may be useful to support informed and shared decision-making (ISDM) by patients and (b) to evaluate the quality of print information materials exchanged during the consultation, i.e. brought in by patients or given out by family physicians.

Design: All print information available for patients and exchanged between physicians and patients was collected in a single complete day of the office practices of 21 family physicians. A published and validated instrument (DISCERN) was used to assess quality.

Setting and participants: Community office practices in the greater Vancouver area, British Columbia, Canada. The physicians were purposefully recruited by their association with the medical school Department of Family Practice, their interest in providing patients with print information and their representation of a range of practice types and location.

Main variables studied: The source of the pamphlets and these categories: available in the physicians' offices; exchanged between physician and patient; and produced with the explicit or apparent intent to support evidence-based patient choice.

Main outcome measures: The quality of the print information to support ISDM, as measured by DISCERN and the ease of use and reliability of the DISCERN tool.

Results and conclusions: Fewer than 50% of pamphlets available in these offices fulfilled our minimum criteria for ISDM (mentioned more than one management option). Offices varied widely in the proportion of pamphlets on display that supported ISDM and how particular the physician was in selecting materials. The DISCERN tool is quick, valid and reliable for the evaluation of patient information. The quality of patient information materials used in the consultation and available in these offices was below midpoint on the DISCERN score. Major deficiencies were with respect to the mention of choices, risks, effect of no treatment or uncertainty and reliability (source, evidence-base). Good quality information can be produced; some is available locally.

Figure 1

The quality of printed consumer health information as measured by the DISCERN total score of 16 items each with a range of 1–5. The box plot shows outliers and percentiles: 90, 75, median, 25 and 10; dotted line = mean. Exchanged (n=53) was information exchanged between physician and patient during the encounter. Wanted (n=14) was information physicians or patients wanted, did not have, but was available in another office. Of fers choices (n=12) was information, culled from the whole collection of 663 pamphlets, which apparently was intended to provide treatment alternatives and choice. EB Patient Choice (n=8) was information published in the UK that explicitly intended to assist evidence‐based patient choice.