US-based cross-sectional survey of clinicians’ knowledge and attitudes about shared decision-making across healthcare professions and specialties

Abstract

ObjectiveIn this study, we aim to compare shared decision-making (SDM) knowledge and attitudes between US-based physician assistants (PAs), nurse practitioners (NPs) and physicians across surgical and family medicine specialties.SettingWe administered a cross-sectional, web-based survey between 20 September 2017 and 1 November 2017.Participants272 US-based NPs, PA and physicians completed the survey. 250 physicians were sent a generic email invitation to participate, of whom 100 completed the survey. 3300 NPs and PAs were invited, among whom 172 completed the survey. Individuals who met the following exclusion criteria were excluded from participation: (1) lack of English proficiency; (2) area of practice other than family medicine or surgery; (3) licensure other than physician, PA or NP; (4) practicing in a country other than the US.ResultsWe found few substantial differences in SDM knowledge and attitudes across clinician types, revealing positive attitudes across the sample paired with low to moderate knowledge. Family medicine professionals (PAs) were most knowledgeable on several items. Very few respondents (3%; 95% CI 1.5% to 6.2%) favoured a paternalistic approach to decision-making.ConclusionsRecent policy-level promotion of SDM may have influenced positive clinician attitudes towards SDM. Positive attitudes despite limited knowledge warrant SDM training across occupations and specialties, while encouraging all clinicians to promote SDM. Given positive attitudes and similar knowledge across clinician types, we recommend that SDM is not confined to the patient-physician dyad but instead advocated among other health professionals.

Exploring healthcare professionals’ knowledge, attitudes and experiences of shared decision making in rheumatology

“…Furthermore, communicative behaviours predefined as conflicting with SDM (ie, ‘Explaining to the patient why a certain treatment is chosen’ and ‘Letting the patient decide after giving thorough information’) were rated as essential for SDM by a substantial proportion of healthcare professionals. These results are consistent with those of studies in other clinical specialisations, indicating that healthcare professionals do not fully grasp the concept of SDM 23 27 28. Consequently, healthcare professionals may mistakenly believe that they apply SDM 29.…”

Observer Ratings of Shared Decision Making Do Not Match Patient Reports: An Observational Study in 5 Family Medicine Practices

“…This implies that, when it comes to medical decisions requiring some amount of time and several patient-clinician encounters, using a single consultation to rate shared decision making may lead to an underestimation of the occurrence and the quality of the decision making process by observers compared to the patient's point of view. This may partly explain why patients' ratings of shared decision making tend to be higher than those of health professionals 12,32,36 and observers. 33,37,38 In addition, our measurements of SDM encompass different aspects of the SDM process.…”

Knowledge of, and attitudes to, shared decision-making in orthodontics in the UK

“…The process for developing the survey is shown in Table 2. The survey was developed using the content of questionnaires used in previously published studies to measure awareness and attitudes to SDM (Durand et al, 2017; Forcino et al, 2018). Durand et al (2017) developed a questionnaire for use with medical students using published literature and focus groups, which was subsequently piloted and modified.…”

“…The four models of the physician–patient relationship (Emanuel and Emanuel, 2017) were the basis for the options in the clinical scenarios. In the second study, Forcino et al (2018) modified this medical student questionnaire for use with a broad range of healthcare professionals. In the present study, the questionnaire was considered alongside other SDM literature regarding awareness and attitudes to SDM and scenarios were adapted to be relevant to orthodontic professionals.…”

“…A recent study of healthcare professionals across six medical disciplines in the USA found a positive attitude to SDM despite a low level of knowledge (Forcino et al, 2018). To date, the knowledge of and attitude of dental professionals specifically to SDM has not been examined in the UK.…”