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Patients' experiences of shared decision making in primary care practices in the United Kingdom

Patients' experiences of shared decision making in primary care practices in the United Kingdom
Patients' experiences of shared decision making in primary care practices in the United Kingdom
BACKGROUND: Shared decision making (SDM) and patient self-management support are key components of US and UK policy for chronic disease management, whereby SDM is seen as enhancing physician-patient negotiation around self-management. The WISE trial is implementing training in self-management support for primary care physicians in one UK region. This article describes preintervention levels of patient-reported SDM and explores how this varies with patient and practice characteristics.

METHODS: We analyzed baseline data from a cluster randomized controlled trial for 2965 patients with diabetes, chronic obstructive pulmonary disease, and irritable bowel syndrome (IBS) from 29 family practices. Patient-level measures included self-report of chronic conditions, SDM (Health Care Climate Questionnaire [HCCQ]), health status, and demographic characteristics. Area and practice characteristics included chronic disease workload and socioeconomic deprivation.

RESULTS: The mean SDM score was 75 (out of 100), but the range was wide. The mean score was lower for IBS patients but did not vary with other disease conditions. Younger patients and those with poorer health status reported lower degrees of SDM. No associations were found with practice characteristics.

LIMITATIONS: The study was restricted to one socioeconomically deprived region, and hence results may not be nationally representative of the United Kingdom. Ceiling effects on SDM scores may limit the utility of the HCCQ.

CONCLUSIONS: Lower ratings from some patient groups may reflect differences in expectations rather than differences in physician behavior. Overall levels of SDM were high, and no patient or practice characteristic represented a serious barrier to SDM. However, we cannot say to what extent SDM in this chronic population addressed self-management issues rather than clinical care. More nuanced measures of SDM are required that distinguish between different forms of care.
shared decision making, decision aids—tools, physician-patient communication, judgment and decision psychology, cohort studies, clinical research methodology
0272-989X
26-36
Fullwood, Catherine
dae7df31-7c47-41a8-bdec-45c1a9c3e985
Kennedy, Anne
e059c1c7-d6d0-41c8-95e1-95e5273b07f8
Rogers, Anne
105eeebc-1899-4850-950e-385a51738eb7
Eden, Martin
fa1b2902-4a0a-44ee-9fb6-0f30ee5d341e
Gardner, Caroline
d99612f8-f7d7-4b42-9d4b-287202c8117c
Protheroe, Joanne
ef666365-4f77-4c8c-9471-967b084dff81
Reeves, David
4d9f4b50-445c-4257-81fe-4d6fa73a9891
Fullwood, Catherine
dae7df31-7c47-41a8-bdec-45c1a9c3e985
Kennedy, Anne
e059c1c7-d6d0-41c8-95e1-95e5273b07f8
Rogers, Anne
105eeebc-1899-4850-950e-385a51738eb7
Eden, Martin
fa1b2902-4a0a-44ee-9fb6-0f30ee5d341e
Gardner, Caroline
d99612f8-f7d7-4b42-9d4b-287202c8117c
Protheroe, Joanne
ef666365-4f77-4c8c-9471-967b084dff81
Reeves, David
4d9f4b50-445c-4257-81fe-4d6fa73a9891

Fullwood, Catherine, Kennedy, Anne, Rogers, Anne, Eden, Martin, Gardner, Caroline, Protheroe, Joanne and Reeves, David (2013) Patients' experiences of shared decision making in primary care practices in the United Kingdom. Medical Decision Making, 33 (1), 26-36. (doi:10.1177/0272989X12464825). (PMID:23128580)

Record type: Article

Abstract

BACKGROUND: Shared decision making (SDM) and patient self-management support are key components of US and UK policy for chronic disease management, whereby SDM is seen as enhancing physician-patient negotiation around self-management. The WISE trial is implementing training in self-management support for primary care physicians in one UK region. This article describes preintervention levels of patient-reported SDM and explores how this varies with patient and practice characteristics.

METHODS: We analyzed baseline data from a cluster randomized controlled trial for 2965 patients with diabetes, chronic obstructive pulmonary disease, and irritable bowel syndrome (IBS) from 29 family practices. Patient-level measures included self-report of chronic conditions, SDM (Health Care Climate Questionnaire [HCCQ]), health status, and demographic characteristics. Area and practice characteristics included chronic disease workload and socioeconomic deprivation.

RESULTS: The mean SDM score was 75 (out of 100), but the range was wide. The mean score was lower for IBS patients but did not vary with other disease conditions. Younger patients and those with poorer health status reported lower degrees of SDM. No associations were found with practice characteristics.

LIMITATIONS: The study was restricted to one socioeconomically deprived region, and hence results may not be nationally representative of the United Kingdom. Ceiling effects on SDM scores may limit the utility of the HCCQ.

CONCLUSIONS: Lower ratings from some patient groups may reflect differences in expectations rather than differences in physician behavior. Overall levels of SDM were high, and no patient or practice characteristic represented a serious barrier to SDM. However, we cannot say to what extent SDM in this chronic population addressed self-management issues rather than clinical care. More nuanced measures of SDM are required that distinguish between different forms of care.

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More information

e-pub ahead of print date: 5 November 2012
Published date: January 2013
Keywords: shared decision making, decision aids—tools, physician-patient communication, judgment and decision psychology, cohort studies, clinical research methodology
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 346116
URI: http://eprints.soton.ac.uk/id/eprint/346116
ISSN: 0272-989X
PURE UUID: 27d18013-ce30-4385-83d7-f72049457b37
ORCID for Anne Kennedy: ORCID iD orcid.org/0000-0003-4570-9104

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Date deposited: 14 Jan 2013 11:53
Last modified: 14 Mar 2024 12:33

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Contributors

Author: Catherine Fullwood
Author: Anne Kennedy ORCID iD
Author: Anne Rogers
Author: Martin Eden
Author: Caroline Gardner
Author: Joanne Protheroe
Author: David Reeves

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