Impact of DECISION + 2 on patient and physician assessment of shared decision making implementation in the context of antibiotics use for acute respiratory infections

Abstract

BackgroundDECISION + 2, a training program for physicians, is designed to implement shared decision making (SDM) in the context of antibiotics use for acute respiratory tract infections (ARTIs). We evaluated the impact of DECISION + 2 on SDM implementation as assessed by patients and physicians, and on physicians’ intention to engage in SDM.MethodsFrom 2010 to 2011, a multi-center, two-arm, parallel randomized clustered trial appraised the effects of DECISION + 2 on the decision to use antibiotics for patients consulting for ARTIs. We randomized 12 family practice teaching units (FPTUs) to either DECISION + 2 or usual care. After the consultation, both physicians and patients independently completed questionnaires based on the D-Option scale regarding SDM behaviors during the consultation. Patients also answered items assessing the role they assumed during the consultation (active/collaborative/passive). Before and after the intervention, physicians completed a questionnaire based on the Theory of Planned Behavior to measure their intention to engage in SDM. To account for the cluster design, we used generalized estimating equations and generalized linear mixed models to assess the impact of DECISION + 2 on the outcomes of interest.ResultsA total of 270 physicians (66% women) participated in the study. After DECISION + 2, patients’ D-Option scores were 80.1 ± 1.1 out of 100 in the intervention group and 74.9 ± 1.1 in the control group (p = 0.001). Physicians’ D-Option scores were 79.7 ± 1.8 in the intervention group and 76.3 ± 1.9 in the control group (p = 0.2). However, subgroup analyses showed that teacher physicians D-Option scores were 79.7 ± 1.5 and 73.0 ± 1.4 respectively (p = 0.001). More patients reported assuming an active or collaborative role in the intervention group (67.1%), than in the control group (49.2%) (p = 0.04). There was a significant relation between patients’ and physicians’ D-Option scores (p < 0.01) and also between patient-reported assumed roles and both D-Option scores (as assessed by patients, p < 0.01; and physicians, p = 0.01). DECISION + 2 had no impact on the intention of physicians to engage in SDM.ConclusionDECISION + 2 positively influenced SDM behaviors as assessed by patients and teacher physicians. Physicians’ intention to engage in SDM was not affected by DECISION + 2.Trial registrationClinicalTrials.gov trials register no. NCT01116076.

Is Shared Decision Making a Utopian Dream or an Achievable Goal?

“…We need to face these new challenges with courage, returning to our original inspiration for new energy, turning to the literature for new evidence, and working towards making respect, sensitivity, and empathy towards the patient a reality in daily practice-and if that sounds highly preference-sensitive, there is evidence that SDM is an 'effective' treatment, i.e. that with SDM, outcomes may be better [39,61]. As we say in Quebec, on lâche pas!…”

Shared decision making in primary care: barriers and facilitators of shared decision making in the context of decreasing the use of unnecessary antibiotics for preschool children ages 3-5 with upper respiratory tract infections

“…Seven articles were chosen to further examine facilitators of shared decision making (Brookes-Howell et al, 2014;Butler et al, 2012;Giguere et al, 2012;Hoye et al, 2010;Legare et al, 2013;Legare et al, 2012;Mangione-Smith et al, 2015). Giguere et al (2012) and Butler et al (2012) provided research on the effects of shared decision making education targeted towards PCPs on antibiotic prescribing trends.…”

“…Giguere et al (2012) and Butler et al (2012) provided research on the effects of shared decision making education targeted towards PCPs on antibiotic prescribing trends. Research by Legare et al (2012) and Legare et al (2013) explored the implementation of shared decision making education into primary care settings.…”

“…Legare et al (2012) and Legare et al (2013) explored PCP education and implementation of shared decision making into practice. Although this research also discussed education of PCPs, it was focused more specifically on implementing shared decision making into practice with education and effective communication.…”

“…Although this research also discussed education of PCPs, it was focused more specifically on implementing shared decision making into practice with education and effective communication. Research by Giguere et al (2012) is linked to the research by Legare et al (2012) and Legare et al (2013). While Giguere et al (2012) studied a shared decision making measurement tool in combination with an education program, Legare et al (2012) looked specifically at the implementation of the program into practice.…”