Exploring doctor and patient views about risk communication and shared decision-making in the consultation

Ruth E Davis; Gina Dolan; Sue Thomas; Christine Atwell; Donna Mead; Sarah Nehammer; Laurie Moseley; Adrian Edwards; Glyn Elwyn

doi:10.1046/j.1369-6513.2003.00235.x

Exploring doctor and patient views about risk communication and shared decision-making in the consultation

Ruth E Davis, Gina Dolan, Sue Thomas, Christine Atwell, Donna Mead, Sarah Nehammer, Laurie Moseley, Adrian Edwards, Glyn Elwyn

Faculty of Life Sciences and Education

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: There have been significant conceptual developments regarding shared decision-making (SDM) and assessments of people's hypothetical preferences for involvement in treatment or care decisions. There are few data on the perceptions of patients and professionals about SDM in actual practice.

OBJECTIVE: To explore, from paired doctor-patient interviews, participants' perceptions of SDM in the consultation and the level of consensus between the participants in the consultation process.

DESIGN: Qualitative analysis of semi-structured interview data.

SETTING AND PARTICIPANTS: Twenty general practitioners received training packages in 'risk communication' (RC) and 'SDM' to use as tools within the consultation. Forty patients with one of four conditions, for which a range of treatment options is available, were selected. Patient/doctor pairs were interviewed separately following consultations at four stages -'baseline' [general practitioner's (GP) usual consultation style], SDM training, RC alone, and both RC and SDM training. Interviews were transcribed and analysed using NVivo software.

RESULTS: Risk communication interventions by doctors appeared to result in a greater perception of decisions being made in the consultation. High levels of satisfaction with consultations were evident before application of the interventions and did not change after the interventions. Doctors' and patients' perceptions of the consultations were highly congruent at all phases of the study.

CONCLUSION: Shared decision-making and RC approaches were helpful in selected consultations and showed no detrimental effects to patients. However, the use of RC and SDM made only small differences to decision-making in consultations within the population studied. Increasing patient participation may be seen as more ethically justifiable than the traditional paternalistic approach but this needs to be set against the additional training costs incurred.

Original language	English
Pages (from-to)	198-207
Number of pages	10
Journal	Health Expectations: An International Journal of Public Participation in Health Care and Health Policy
Volume	6
Issue number	3
DOIs	https://doi.org/10.1046/j.1369-6513.2003.00235.x
Publication status	Published - 27 Aug 2003

Keywords

Adult
Aged
Attitude of Health Personnel
Communication
Decision Making
Family Practice
Female
Great Britain
Health Services Research
Humans
Interviews as Topic
Male
Middle Aged
Patient Participation
Patient Satisfaction
Physician-Patient Relations
Qualitative Research
Risk Assessment

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10.1046/j.1369-6513.2003.00235.xLicence: CC BY-NC-ND

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Davis, R. E., Dolan, G., Thomas, S., Atwell, C., Mead, D., Nehammer, S., Moseley, L., Edwards, A., & Elwyn, G. (2003). Exploring doctor and patient views about risk communication and shared decision-making in the consultation. Health Expectations: An International Journal of Public Participation in Health Care and Health Policy, 6(3), 198-207. https://doi.org/10.1046/j.1369-6513.2003.00235.x

@article{5cfbcd069a8b40958cd0b544ce4081ab,

title = "Exploring doctor and patient views about risk communication and shared decision-making in the consultation",

abstract = "BACKGROUND: There have been significant conceptual developments regarding shared decision-making (SDM) and assessments of people's hypothetical preferences for involvement in treatment or care decisions. There are few data on the perceptions of patients and professionals about SDM in actual practice.OBJECTIVE: To explore, from paired doctor-patient interviews, participants' perceptions of SDM in the consultation and the level of consensus between the participants in the consultation process.DESIGN: Qualitative analysis of semi-structured interview data.SETTING AND PARTICIPANTS: Twenty general practitioners received training packages in 'risk communication' (RC) and 'SDM' to use as tools within the consultation. Forty patients with one of four conditions, for which a range of treatment options is available, were selected. Patient/doctor pairs were interviewed separately following consultations at four stages -'baseline' [general practitioner's (GP) usual consultation style], SDM training, RC alone, and both RC and SDM training. Interviews were transcribed and analysed using NVivo software.RESULTS: Risk communication interventions by doctors appeared to result in a greater perception of decisions being made in the consultation. High levels of satisfaction with consultations were evident before application of the interventions and did not change after the interventions. Doctors' and patients' perceptions of the consultations were highly congruent at all phases of the study.CONCLUSION: Shared decision-making and RC approaches were helpful in selected consultations and showed no detrimental effects to patients. However, the use of RC and SDM made only small differences to decision-making in consultations within the population studied. Increasing patient participation may be seen as more ethically justifiable than the traditional paternalistic approach but this needs to be set against the additional training costs incurred.",

keywords = "Adult, Aged, Attitude of Health Personnel, Communication, Decision Making, Family Practice, Female, Great Britain, Health Services Research, Humans, Interviews as Topic, Male, Middle Aged, Patient Participation, Patient Satisfaction, Physician-Patient Relations, Qualitative Research, Risk Assessment",

author = "Davis, {Ruth E} and Gina Dolan and Sue Thomas and Christine Atwell and Donna Mead and Sarah Nehammer and Laurie Moseley and Adrian Edwards and Glyn Elwyn",

year = "2003",

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doi = "10.1046/j.1369-6513.2003.00235.x",

language = "English",

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Davis, RE, Dolan, G, Thomas, S, Atwell, C, Mead, D, Nehammer, S, Moseley, L, Edwards, A & Elwyn, G 2003, 'Exploring doctor and patient views about risk communication and shared decision-making in the consultation', Health Expectations: An International Journal of Public Participation in Health Care and Health Policy, vol. 6, no. 3, pp. 198-207. https://doi.org/10.1046/j.1369-6513.2003.00235.x

Exploring doctor and patient views about risk communication and shared decision-making in the consultation. / Davis, Ruth E; Dolan, Gina; Thomas, Sue et al.
In: Health Expectations: An International Journal of Public Participation in Health Care and Health Policy, Vol. 6, No. 3, 27.08.2003, p. 198-207.

Research output: Contribution to journal › Article › peer-review

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T1 - Exploring doctor and patient views about risk communication and shared decision-making in the consultation

AU - Davis, Ruth E

AU - Dolan, Gina

AU - Thomas, Sue

AU - Atwell, Christine

AU - Mead, Donna

AU - Nehammer, Sarah

AU - Moseley, Laurie

AU - Edwards, Adrian

AU - Elwyn, Glyn

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Y1 - 2003/8/27

N2 - BACKGROUND: There have been significant conceptual developments regarding shared decision-making (SDM) and assessments of people's hypothetical preferences for involvement in treatment or care decisions. There are few data on the perceptions of patients and professionals about SDM in actual practice.OBJECTIVE: To explore, from paired doctor-patient interviews, participants' perceptions of SDM in the consultation and the level of consensus between the participants in the consultation process.DESIGN: Qualitative analysis of semi-structured interview data.SETTING AND PARTICIPANTS: Twenty general practitioners received training packages in 'risk communication' (RC) and 'SDM' to use as tools within the consultation. Forty patients with one of four conditions, for which a range of treatment options is available, were selected. Patient/doctor pairs were interviewed separately following consultations at four stages -'baseline' [general practitioner's (GP) usual consultation style], SDM training, RC alone, and both RC and SDM training. Interviews were transcribed and analysed using NVivo software.RESULTS: Risk communication interventions by doctors appeared to result in a greater perception of decisions being made in the consultation. High levels of satisfaction with consultations were evident before application of the interventions and did not change after the interventions. Doctors' and patients' perceptions of the consultations were highly congruent at all phases of the study.CONCLUSION: Shared decision-making and RC approaches were helpful in selected consultations and showed no detrimental effects to patients. However, the use of RC and SDM made only small differences to decision-making in consultations within the population studied. Increasing patient participation may be seen as more ethically justifiable than the traditional paternalistic approach but this needs to be set against the additional training costs incurred.

AB - BACKGROUND: There have been significant conceptual developments regarding shared decision-making (SDM) and assessments of people's hypothetical preferences for involvement in treatment or care decisions. There are few data on the perceptions of patients and professionals about SDM in actual practice.OBJECTIVE: To explore, from paired doctor-patient interviews, participants' perceptions of SDM in the consultation and the level of consensus between the participants in the consultation process.DESIGN: Qualitative analysis of semi-structured interview data.SETTING AND PARTICIPANTS: Twenty general practitioners received training packages in 'risk communication' (RC) and 'SDM' to use as tools within the consultation. Forty patients with one of four conditions, for which a range of treatment options is available, were selected. Patient/doctor pairs were interviewed separately following consultations at four stages -'baseline' [general practitioner's (GP) usual consultation style], SDM training, RC alone, and both RC and SDM training. Interviews were transcribed and analysed using NVivo software.RESULTS: Risk communication interventions by doctors appeared to result in a greater perception of decisions being made in the consultation. High levels of satisfaction with consultations were evident before application of the interventions and did not change after the interventions. Doctors' and patients' perceptions of the consultations were highly congruent at all phases of the study.CONCLUSION: Shared decision-making and RC approaches were helpful in selected consultations and showed no detrimental effects to patients. However, the use of RC and SDM made only small differences to decision-making in consultations within the population studied. Increasing patient participation may be seen as more ethically justifiable than the traditional paternalistic approach but this needs to be set against the additional training costs incurred.

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KW - Aged

KW - Attitude of Health Personnel

KW - Communication

KW - Decision Making

KW - Family Practice

KW - Female

KW - Great Britain

KW - Health Services Research

KW - Humans

KW - Interviews as Topic

KW - Male

KW - Middle Aged

KW - Patient Participation

KW - Patient Satisfaction

KW - Physician-Patient Relations

KW - Qualitative Research

KW - Risk Assessment

U2 - 10.1046/j.1369-6513.2003.00235.x

DO - 10.1046/j.1369-6513.2003.00235.x

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JO - Health Expectations: An International Journal of Public Participation in Health Care and Health Policy

JF - Health Expectations: An International Journal of Public Participation in Health Care and Health Policy

IS - 3

ER -

Exploring doctor and patient views about risk communication and shared decision-making in the consultation

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Keywords

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