Shared decision making and antibiotic benefit-harm conversations: an observational study of consultations between general practitioners and patients with acute respiratory infections
Abstract Background Little research has examined whether shared decision making (SDM) occurs in consultations for acute respiratory infections (ARIs), including what, and how, antibiotic benefits and harms are discussed. We aimed to analyse the extent and nature of SDM in consultations between GPs a...
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| Format: | Article |
| Language: | English |
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BMC
2018-10-01
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| Series: | BMC Family Practice |
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| Online Access: | http://link.springer.com/article/10.1186/s12875-018-0854-y |
| _version_ | 1818470652632367104 |
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| author | Mina Bakhit Chris Del Mar Elizabeth Gibson Tammy Hoffmann |
| author_facet | Mina Bakhit Chris Del Mar Elizabeth Gibson Tammy Hoffmann |
| author_sort | Mina Bakhit |
| collection | DOAJ |
| description | Abstract Background Little research has examined whether shared decision making (SDM) occurs in consultations for acute respiratory infections (ARIs), including what, and how, antibiotic benefits and harms are discussed. We aimed to analyse the extent and nature of SDM in consultations between GPs and patients with ARIs, and explore communication with and without the use of patient decision aids. Methods This was an observational study in Australian general practices, nested within a cluster randomised trial of decision aids (for acute otitis media [AOM], sore throat, acute bronchitis) designed for general practitioners (GPs) to use with patients, compared with usual care (no decision aids). Audio-recordings of consultations of a convenience sample of consenting patients seeing a GP for an ARI were independently analysed by two raters using the OPTION-12 (observing patient involvement in decision making) scale (maximum score of 100) and 5 items (about communicating evidence) from the Assessing Communication about Evidence and Patient Preferences (ACEPP) tool (maximum score of 5). Patients also self-completed a questionnaire post-consultation that contained items from CollaboRATE-5 (perceptions of involvement in the decision-making process), a decisional conflict scale, and a decision self-efficacy scale. Descriptive statistics were calculated for each measure. Results Thirty-six consultations, involving 13 GPs, were recorded (20 for bronchitis, 10 sore throat, 6 AOM). The mean (SD) total OPTION-12 score was 29.4 (12.5; range 4–54), with item 12 (need to review decision) the highest (mean = 3) and item 10 (eliciting patients’ preferred level of decision-making involvement) the lowest (mean = 0.1). The mean (SD) total ACEPP score was 2 (1.6), with the item about discussing benefits scoring highest. In consultations where a decision aid was used (15, 42%), compared to the 21 usual care consultations, mean observer-assessed SDM scores (OPTION-12, ACEPP scores) were higher and antibiotic harms mentioned in all (compared to only 1) consultations. Patients generally reported high decision involvement and self-efficacy, and low decisional conflict. Conclusions The extent of observer-assessed SDM between GPs and patients with ARIs was generally low. Balanced discussion of antibiotic benefits and harms occurred more often when decision aids were used. |
| first_indexed | 2024-04-13T21:40:01Z |
| format | Article |
| id | doaj.art-8be21daee24e44d7b29399f28dadc8f8 |
| institution | Directory Open Access Journal |
| issn | 1471-2296 |
| language | English |
| last_indexed | 2024-04-13T21:40:01Z |
| publishDate | 2018-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Family Practice |
| spelling | doaj.art-8be21daee24e44d7b29399f28dadc8f82022-12-22T02:28:48ZengBMCBMC Family Practice1471-22962018-10-011911910.1186/s12875-018-0854-yShared decision making and antibiotic benefit-harm conversations: an observational study of consultations between general practitioners and patients with acute respiratory infectionsMina Bakhit0Chris Del Mar1Elizabeth Gibson2Tammy Hoffmann3Centre for Research in Evidence-Based Practice (CREBP), Faculty of Health Sciences and Medicine, Bond UniversityCentre for Research in Evidence-Based Practice (CREBP), Faculty of Health Sciences and Medicine, Bond UniversityCentre for Research in Evidence-Based Practice (CREBP), Faculty of Health Sciences and Medicine, Bond UniversityCentre for Research in Evidence-Based Practice (CREBP), Faculty of Health Sciences and Medicine, Bond UniversityAbstract Background Little research has examined whether shared decision making (SDM) occurs in consultations for acute respiratory infections (ARIs), including what, and how, antibiotic benefits and harms are discussed. We aimed to analyse the extent and nature of SDM in consultations between GPs and patients with ARIs, and explore communication with and without the use of patient decision aids. Methods This was an observational study in Australian general practices, nested within a cluster randomised trial of decision aids (for acute otitis media [AOM], sore throat, acute bronchitis) designed for general practitioners (GPs) to use with patients, compared with usual care (no decision aids). Audio-recordings of consultations of a convenience sample of consenting patients seeing a GP for an ARI were independently analysed by two raters using the OPTION-12 (observing patient involvement in decision making) scale (maximum score of 100) and 5 items (about communicating evidence) from the Assessing Communication about Evidence and Patient Preferences (ACEPP) tool (maximum score of 5). Patients also self-completed a questionnaire post-consultation that contained items from CollaboRATE-5 (perceptions of involvement in the decision-making process), a decisional conflict scale, and a decision self-efficacy scale. Descriptive statistics were calculated for each measure. Results Thirty-six consultations, involving 13 GPs, were recorded (20 for bronchitis, 10 sore throat, 6 AOM). The mean (SD) total OPTION-12 score was 29.4 (12.5; range 4–54), with item 12 (need to review decision) the highest (mean = 3) and item 10 (eliciting patients’ preferred level of decision-making involvement) the lowest (mean = 0.1). The mean (SD) total ACEPP score was 2 (1.6), with the item about discussing benefits scoring highest. In consultations where a decision aid was used (15, 42%), compared to the 21 usual care consultations, mean observer-assessed SDM scores (OPTION-12, ACEPP scores) were higher and antibiotic harms mentioned in all (compared to only 1) consultations. Patients generally reported high decision involvement and self-efficacy, and low decisional conflict. Conclusions The extent of observer-assessed SDM between GPs and patients with ARIs was generally low. Balanced discussion of antibiotic benefits and harms occurred more often when decision aids were used.http://link.springer.com/article/10.1186/s12875-018-0854-yDecision makingGeneral practiceRespiratory tract infectionsDecision support techniquesPhysician-patient relations |
| spellingShingle | Mina Bakhit Chris Del Mar Elizabeth Gibson Tammy Hoffmann Shared decision making and antibiotic benefit-harm conversations: an observational study of consultations between general practitioners and patients with acute respiratory infections BMC Family Practice Decision making General practice Respiratory tract infections Decision support techniques Physician-patient relations |
| title | Shared decision making and antibiotic benefit-harm conversations: an observational study of consultations between general practitioners and patients with acute respiratory infections |
| title_full | Shared decision making and antibiotic benefit-harm conversations: an observational study of consultations between general practitioners and patients with acute respiratory infections |
| title_fullStr | Shared decision making and antibiotic benefit-harm conversations: an observational study of consultations between general practitioners and patients with acute respiratory infections |
| title_full_unstemmed | Shared decision making and antibiotic benefit-harm conversations: an observational study of consultations between general practitioners and patients with acute respiratory infections |
| title_short | Shared decision making and antibiotic benefit-harm conversations: an observational study of consultations between general practitioners and patients with acute respiratory infections |
| title_sort | shared decision making and antibiotic benefit harm conversations an observational study of consultations between general practitioners and patients with acute respiratory infections |
| topic | Decision making General practice Respiratory tract infections Decision support techniques Physician-patient relations |
| url | http://link.springer.com/article/10.1186/s12875-018-0854-y |
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