‘They leave at least believing they had a part in the discussion’: Understanding decision aid use and patient–clinician decision-making through qualitative research

Abstract Objective This study explores how patient decision aids (DAs) for antihyperglycemic agents and statins, designed for use during clinical consultations, are embedded into practice, examining how patients and clinicians understand and experience DAs in primary care visits. Methods We conducte...

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Bibliographic Details
Published in:Patient education and counseling 2013-10, Vol.93 (1), p.86-94
Main Authors: Tiedje, Kristina, Shippee, Nathan D, Johnson, Anna M, Flynn, Priscilla M, Finnie, Dawn M, Liesinger, Juliette T, May, Carl R, Olson, Marianne E, Ridgeway, Jennifer L, Shah, Nilay D, Yawn, Barbara P, Montori, Victor M
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Communication
Consultation
Decision aids
Decision Making
Decision Support Techniques
Diabetes Mellitus
Diabetes Mellitus, Type 2 - drug therapy
Drivers
Female
Grounded theory
Humans
Identification
Internal Medicine
Male
Middle Aged
Nursing
Outcome and Process Assessment (Health Care)
Patient Participation
Physician-Patient Relations
Primary health care
Primary Health Care - methods
Provider–patient communication
Qualitative Research
Rural Health Services - organization & administration
Shared decision making
Socioeconomic Factors
Urban Health Services - organization & administration
Young Adult
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Summary:Abstract Objective This study explores how patient decision aids (DAs) for antihyperglycemic agents and statins, designed for use during clinical consultations, are embedded into practice, examining how patients and clinicians understand and experience DAs in primary care visits. Methods We conducted semistructured in-depth interviews with patients ( n = 22) and primary care clinicians ( n = 19), and videorecorded consultations ( n = 44). Two researchers coded all transcripts. Inductive analyses guided by grounded theory led to the identification of themes. Video and interview data were compared and organized by themes. Results DAs used during consultations became flexible artifacts, incorporated into existing decision making roles for clinicians (experts, authority figures, persuaders, advisors) and patients (drivers of healthcare, learners, partners). DAs were applied to different decision making steps (deliberation, bargaining, convincing, case assessment), and introduced into an existing knowledge context (participants’ literacy regarding shared decision-making (SDM) and DAs). Conclusion DAs’ flexible use during consultations effectively provided space for discussion, even when SDM was not achieved. DAs can be used within any decision-making model. Practice implications Clinician training in DA use and SDM practice may be needed to facilitate DA implementation and promote more ideal-type forms of sharing in decision making.
ISSN:0738-3991
1873-5134
DOI:10.1016/j.pec.2013.03.013