Exploring dietitians' salient beliefs about shared decision-making behaviors

Sophie Desroches,Sarah-Maude Deschênes,Annie Lapointe,Marie-Pierre Gagnon,France Légaré

doi:10.1186/1748-5908-6-57

Abstract

BackgroundShared decision making (SDM), a process by which health professionals and patients go through the decision-making process together to agree on treatment, is a promising strategy for promoting diet-related decisions that are informed and value based and to which patients adhere well. The objective of the present study was to identify dietitians' salient beliefs regarding their exercise of two behaviors during the clinical encounter, both of which have been deemed essential for SDM to take place: (1) presenting patients with all dietary treatment options for a given health condition and (2) helping patients clarify their values and preferences regarding the options.MethodsTwenty-one dietitians were allocated to four focus groups. Facilitators conducted the focus groups using a semistructured interview guide based on the Theory of Planned Behavior. Discussions were audiotaped, transcribed verbatim, coded, and analyzed with NVivo8 (QSR International, Cambridge, MA) software.ResultsMost participants stated that better patient adherence to treatment was an advantage of adopting the two SDM behaviors. Dietitians identified patients, physicians, and the multidisciplinary team as normative referents who would approve or disapprove of their adoption of the SDM behaviors. The most often reported barriers and facilitators for the behaviors concerned patients' characteristics, patients' clinical situation, and time.ConclusionsThe implementation of SDM in nutrition clinical practice can be guided by addressing dietitians' salient beliefs. Identifying these beliefs also provides the theoretical framework needed for developing a quantitative survey questionnaire to further study the determinants of dietitians' adoption of SDM behaviors.

Highlights

Shared decision making (SDM), a process by which health professionals and patients go through the decision-making process together to agree on treatment, is a promising strategy for promoting diet-related decisions that are informed and value based and to which patients adhere well
SDM is positioned as the middle ground between the paternalistic model, where the health professional assumes the leading role in treatment decisions, and the informed patient choice model, where the health professional’s role is limited to giving
SDM is increasingly advocated in healthcare because of its potential to improve the decision-making process for patients and increase patients’ adherence to the treatment decision, improving patient outcomes as a result [6,7]

Summary

Introduction

Shared decision making (SDM), a process by which health professionals and patients go through the decision-making process together to agree on treatment, is a promising strategy for promoting diet-related decisions that are informed and value based and to which patients adhere well. The past two decades have witnessed growing interest in the decision-making processes that occur during clinical encounters. One of these processes is shared decision making (SDM), in which a healthcare choice is made jointly by the health professional and the patient [1]. Despite growing clinical interest in SDM, barriers to its implementation remain [10], and SDM has not yet been widely adopted by health professionals [11] This said, SDM comprises a set of behaviors that could be modified by activities designed to foster its practice. Less is known about whether other health professionals, such as dietitians, encounter the same difficulty, the vast majority of studies on SDM having been conducted among patients [6] and physicians [10]

Objectives

Methods

Results

Discussion

Conclusion