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Observational Study
. 2024 Feb 28;41(1):50-59.
doi: 10.1093/fampra/cmad125.

Shared decision-making performance of general practice residents: an observational study combining observer, resident, and patient perspectives

Anouk Baghus  1 , Esther Giroldi  1   2 , Jasper van Geel  1 , Arthur Leferink  1 , Marjolein H J van de Pol  3 , Ariëtte Sanders  4 , Patrick W Dielissen  3 , Isabella Bisschop  5 , Arwen H Pieterse  6 , Jean W M Muris  1 , Angelique A Timmerman  1 , Trudy van der Weijden  1
Affiliations
Observational Study

Shared decision-making performance of general practice residents: an observational study combining observer, resident, and patient perspectives

Anouk Baghus et al. Fam Pract. .

Abstract

Background: Shared decision making (SDM) is considered fundamental to person-centred care. However, applying SDM may be a challenge for residents in general practice, since it is a complex competence that requires the integration of knowledge and skills from several competency domains.

Objective: To support learning of SDM during medical residency, we aimed to gain insight in Dutch residents' observed and perceived SDM performance in general practice.

Methods: We evaluated residents' SDM performance from an observer, resident, and patient perspective. Consultations of first- and third-year residents were recorded. Trained observers used the validated Observing Patient Involvement (OPTION5) scale to assess observed SDM performance of residents in 98 actual recorded consultations. Perceived SDM performance was evaluated by residents and patients completing validated SDM questionnaires, supplemented with questions about (the context of) the consultation and perceived relevance of SDM immediately after the consultation. The data were analysed using descriptive statistics (mean, SD, minimums, and maximums) and explorative bivariate analyses.

Results: The residents' observed mean SDM performance was 19.1 (range, 0-100, SD = 10.9), mean resident self-reported SDM performance was 56.9 (range, 0-100, SD = 18.5), and mean patient-reported SDM performance was 73.3 (range, 0-100, SD = 26.8). We found a significant and positive correlation between observed SDM performance and residents' perceived relevance of SDM for the consultation (t = 4.571, P ≤ 0.001) and the duration of the consultation (r = 0.390, P ≤ 0.001).

Conclusions: This study showed that there is room for increasing awareness of the potential incongruence between observed and perceived SDM performance during medical residency, in order to facilitate the implementation of SDM in clinical practice.

Keywords: decision making; education; general practice; graduate; medical; observational study; patient involvement; patient-centred care; shared.

Plain language summary

The problem: Shared decision making is an important process in which healthcare professional and patient work together to reach a decision on how to solve a health problem. This decision should include patients’ needs and what matters most to them. We investigated if consultations between general practitioners in training (i.e. residents) and their patients demonstrate shared decision making. The research methods: We asked the residents and patients to respond to questions on their experience of shared decision making right after the consultation. We recorded 98 consultations of residents with their patients. Two researchers rated to what extent residents demonstrated shared decision-making behaviours during these consultations.

The results: The patients reported more shared decision making than the residents (patients: 73 versus residents: 57 on a 0–100 scale). The researchers observed low levels of SDM during the consultations (19 on a 0–100 scale). Our conclusion: Residents should be aware that shared decision making does not yet frequently occur in practice. To improve the extent to which residents share decisions with their patients in general practice, residents should learn why, when, and how to involve patients in decision making during consultations.

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Conflict of interest statement

None.

Figures

Fig. 1.
Fig. 1.
Flow-chart of the process of inclusion of participating general practice residents and patients, and the sources and number of data collected for a study of shared decision-making performance in medical residency, 2017–2019. Abbreviations: OPTION, observing patient involvement; SDM-Q-Doc, shared decision-making questionnaire filled in by residents; SDM-Q-9, shared decision-making questionnaire filled in by patients. aThese incomplete questionnaires are included in the total score of SDM-Q-Doc/SDM-Q-9. bThese incomplete questionnaires are not included in the total score of SDM-Q-9.
Fig. 2.
Fig. 2.
Scatter plot of observed shared decision-making performance (total OPTION5 scores) (n = 98) and residents’ perceptions of shared decision-making performance (total SDM-Q-Doc scores) (n = 98) for a study of shared decision-making performance in medical residency, 2017–2019. Abbreviations: OPTION = Observing Patient Involvement; SDM-Q-Doc = shared decision-making questionnaire filled in by residents
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