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Medical communication and technology: a video-based process study of the use of decision aids in primary care

Medical communication and technology: a video-based process study of the use of decision aids in primary care
Medical communication and technology: a video-based process study of the use of decision aids in primary care
Background: much of the research on decision-making in health care has focused on consultation outcomes. Less is known about the process by which clinicians and patients come to a treatment decision. This study aimed to quantitatively describe the behaviour shown by doctors and patients during primary care consultations when three types of decision aids were used to promote treatment decision-making in a randomised controlled trial.

Methods: a video-based study set in an efficacy trial which compared the use of paper-based guidelines (control) with two forms of computer-based decision aids (implicit and explicit versions of DARTS II). Treatment decision concerned warfarin anti-coagulation to reduce the risk of stroke in older patients with atrial fibrillation. Twenty nine consultations were video-recorded. A ten-minute 'slice' of the consultation was sampled for detailed content analysis using existing interaction analysis protocols for verbal behaviour and ethological techniques for non-verbal behaviour.

Results: median consultation times (quartiles) differed significantly depending on the technology used. Paper-based guidelines took 21 (19–26) minutes to work through compared to 31 (16–41) minutes for the implicit tool; and 44 (39–55) minutes for the explicit tool. In the ten minutes immediately preceding the decision point, GPs dominated the conversation, accounting for 64% (58–66%) of all utterances and this trend was similar across all three arms of the trial. Information-giving was the most frequent activity for both GPs and patients, although GPs did this at twice the rate compared to patients and at higher rates in consultations involving computerised decision aids. GPs' language was highly technically focused and just 7% of their conversation was socio-emotional in content; this was half the socio-emotional content shown by patients (15%). However, frequent head nodding and a close mirroring in the direction of eye-gaze suggested that both parties were active participants in the conversation

Conclusion: irrespective of the arm of the trial, both patients' and GPs' behaviour showed that they were reciprocally engaged in these consultations. However, even in consultations aimed at promoting shared decision-making, GPs' were verbally dominant, and they worked primarily as information providers for patients. In addition, computer-based decision aids significantly prolonged the consultations, particularly the later phases. These data suggest that decision aids may not lead to more 'sharing' in treatment decision-making and that, in their current form, they may take too long to negotiate for use in routine primary care
1-11
Kaner, Eileen
dd32baba-7237-4a2c-ae71-9c411af36ff2
Heaven, Ben
c1450e21-13bc-467f-98b4-6c6f233139c1
Rapley, Tim
eb4364d5-c016-403a-969a-aae1fd35a97c
Murtagh, Madeleine
25c1b33b-78f0-47f7-be84-e60ac5a41cfc
Graham, Ruth
51cb25c6-246e-4e22-811c-c5d3cf89cebf
Thomson, Richard
e9f815c0-7122-4fdc-9bd7-f867139e614f
May, Carl
17697f8d-98f6-40d3-9cc0-022f04009ae4
Kaner, Eileen
dd32baba-7237-4a2c-ae71-9c411af36ff2
Heaven, Ben
c1450e21-13bc-467f-98b4-6c6f233139c1
Rapley, Tim
eb4364d5-c016-403a-969a-aae1fd35a97c
Murtagh, Madeleine
25c1b33b-78f0-47f7-be84-e60ac5a41cfc
Graham, Ruth
51cb25c6-246e-4e22-811c-c5d3cf89cebf
Thomson, Richard
e9f815c0-7122-4fdc-9bd7-f867139e614f
May, Carl
17697f8d-98f6-40d3-9cc0-022f04009ae4

Kaner, Eileen, Heaven, Ben, Rapley, Tim, Murtagh, Madeleine, Graham, Ruth, Thomson, Richard and May, Carl (2007) Medical communication and technology: a video-based process study of the use of decision aids in primary care. BMC Medical Informatics and Decision Making, 7, 1-11. (doi:10.1186/1472-6947-7-2).

Record type: Article

Abstract

Background: much of the research on decision-making in health care has focused on consultation outcomes. Less is known about the process by which clinicians and patients come to a treatment decision. This study aimed to quantitatively describe the behaviour shown by doctors and patients during primary care consultations when three types of decision aids were used to promote treatment decision-making in a randomised controlled trial.

Methods: a video-based study set in an efficacy trial which compared the use of paper-based guidelines (control) with two forms of computer-based decision aids (implicit and explicit versions of DARTS II). Treatment decision concerned warfarin anti-coagulation to reduce the risk of stroke in older patients with atrial fibrillation. Twenty nine consultations were video-recorded. A ten-minute 'slice' of the consultation was sampled for detailed content analysis using existing interaction analysis protocols for verbal behaviour and ethological techniques for non-verbal behaviour.

Results: median consultation times (quartiles) differed significantly depending on the technology used. Paper-based guidelines took 21 (19–26) minutes to work through compared to 31 (16–41) minutes for the implicit tool; and 44 (39–55) minutes for the explicit tool. In the ten minutes immediately preceding the decision point, GPs dominated the conversation, accounting for 64% (58–66%) of all utterances and this trend was similar across all three arms of the trial. Information-giving was the most frequent activity for both GPs and patients, although GPs did this at twice the rate compared to patients and at higher rates in consultations involving computerised decision aids. GPs' language was highly technically focused and just 7% of their conversation was socio-emotional in content; this was half the socio-emotional content shown by patients (15%). However, frequent head nodding and a close mirroring in the direction of eye-gaze suggested that both parties were active participants in the conversation

Conclusion: irrespective of the arm of the trial, both patients' and GPs' behaviour showed that they were reciprocally engaged in these consultations. However, even in consultations aimed at promoting shared decision-making, GPs' were verbally dominant, and they worked primarily as information providers for patients. In addition, computer-based decision aids significantly prolonged the consultations, particularly the later phases. These data suggest that decision aids may not lead to more 'sharing' in treatment decision-making and that, in their current form, they may take too long to negotiate for use in routine primary care

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Published date: January 2007

Identifiers

Local EPrints ID: 163559
URI: http://eprints.soton.ac.uk/id/eprint/163559
PURE UUID: 9674f7fa-014f-481d-bb67-a132ca77aaad
ORCID for Carl May: ORCID iD orcid.org/0000-0002-0451-2690

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Date deposited: 09 Sep 2010 10:24
Last modified: 14 Mar 2024 02:05

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Contributors

Author: Eileen Kaner
Author: Ben Heaven
Author: Tim Rapley
Author: Madeleine Murtagh
Author: Ruth Graham
Author: Richard Thomson
Author: Carl May ORCID iD

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