Do consultants do what they say they do? Observational study of the extent to which clinicians involve their patients in the decision-making process

Abstract

ObjectivesTo assess whether consultants do what they say they do in reaching decisions with their patients.DesignCross-sectional analysis of hospital outpatient encounters, comparing consultants’ self-reported usual decision-making style to their actual observed decision-making behaviour in video-recorded encounters.SettingLarge secondary care teaching hospital in the Netherlands.Participants41 consultants from 18 disciplines and 781 patients.Primary and secondary outcome measureWith the Control Preference Scale, the self-reported usual decision-making style was assessed (paternalistic, informative or shared decision making). Two independent raters assessed decision-making behaviour for each decision using the Observing Patient Involvement (OPTION)5 instrument ranging from 0 (no shared decision making (SDM)) to 100 (optimal SDM).ResultsConsultants reported their usual decision-making style as informative (n=11), shared (n=16) and paternalistic (n=14). Overall, patient involvement was low, with mean (SD) OPTION5 scores of 16.8 (17.1). In an unadjusted multilevel analysis, the reported usual decision-making style was not related to the OPTION5 score (p>0.156). After adjusting for patient, consultant and consultation characteristics, higher OPTION5 scores were only significantly related to the category of decisions (treatment vs the other categories) and to longer consultation duration (p<0.001).ConclusionsThe limited patient involvement that we observed was not associated with the consultants’ self-reported usual decision-making style. Consultants appear to be unconsciously incompetent in shared decision making. This can hinder the transfer of this crucial communication skill to students and junior doctors.

Shared decision-making in the Netherlands: Progress is made, but not for all. Time to become inclusive to patients

“…The findings reported in Figure 2 on patients' subjective experience of SDM may be looked upon critically if we study objective behavior. Analysis of video-recorded encounters of 781 patients in consultation with 41 specialists from various disciplines showed an overall low level of patient involvement (mean OPTION5 scores 16.8, SD 17.1, scale range 0-100) [18]. The study suggested incompetence in SDM, of which specialists were unaware.…”

“…Training physicians in SDM will only be effective if they are made aware of their limited application of SDM in daily clinical practice. Many Dutch physicians are in the stage of being unconsciously incompetent in SDM, making them unfit to teach SDM to residents and medical students [18]. As a basis for the design of workplace learning for postgraduate training on SDM, national consensus was found on so-called 'entrustable professional activities' (competences) comprising 18 behavioral SDM indicators [32].…”

Influence of AI-based decision support on shared decision making in hemodialysis: a Wizard of Oz experiment

“…It has been shown for other disease contexts that SDM, while being preferred by physicians, is not as often performed in clinical practice. 27,28 It is conceivable that SDM is well implemented for simple decisions in hemodialysis treatment, but informative or paternalistic decision making styles are used for more complex ones. 29,30 Regarding the potential use of AI-DSS in hemodialysis, patients identified optimization of dry weight, and fluid removal as one potential use case as well.…”

Shared decision-making between paediatric haematologists, children with sickle cell disease and their parents: an exploratory study

“…This was also observed in previous studies in other areas of medicine [ 28 ] . In our study, this may be due to a (possibly unconscious) treatment preference among paediatricians, which may have led to discussing only one option, and thereby nudging the parent/patient to choose this option [ 29 , 30 ]. Audio-recordings indicated a discrepancy between consistently applying SDM compared to advising what was considered by paediatricians as the best available treatment option.…”