Abstract
PurposeShared decision making calls for clinician communication strategies that aim to foster choice awareness and to present treatment options neutrally, such as by not showing a preference. Evidence for the effectiveness of these communication strategies to enhance patient involvement in treatment decision making is lacking. We tested the effects of 2 strategies in an online randomized video-vignettes experiment.MethodsWe developed disease-specific video vignettes for rheumatic disease, cancer, and kidney disease showcasing a physician presenting 2 treatment options. We tested the strategies in a 2 (choice awareness communication present/absent) by 2 (physician preference communication present/absent) randomized between-subjects design. We asked patients and disease-naïve participants to view 1 video vignette while imagining being the patient and to report perceived room for involvement (primary outcome), understanding of treatment information, treatment preference, satisfaction with the consultation, and trust in the physician (secondary outcomes). Differences across experimental conditions were assessed using 2-way analyses of variance.ResultsA total of 324 patients and 360 disease-naïve respondents participated (mean age, 52 ± 14.7 y, 54% female, 56% lower educated, mean health literacy, 12 ± 2.1 on a 3–15 scale). The results showed that choice awareness communication had a positive (Mpresent = 5.2 v. Mabsent = 5.0, P = 0.042, η2partial = 0.006) and physician preference communication had no (Mpresent = 5.0 v. Mabsent = 5.1, P = 0.144, η2partial = 0.003) significant effect on perceived room for involvement in decision making. Physician preference communication steered patients toward preferring that treatment option (Mpresent = 4.7 v. Mabsent = 5.3, P = 0.006, η2partial = 0.011). The strategies had no significant effect on understanding, satisfaction, or trust.ConclusionsThis is the first experimental evidence for a small effect of fostering choice awareness and no effect of physician preference on perceived room to participate in decision making. Physician preference steered patients toward preferring that option.
Highlights
IntroductionDisease-naıve participants were asked whether they had been treated for a disease that had required 4 or more hospital visits or bimonthly visits to their general practitioner in the past 5 years and, if so, what disease (i.e., diabetes, cardiovascular disease, disease of the lungs/airways, skin disease, or other to specify)
Background characteristicsParticipants were asked to indicate their gender, year of birth, education, and their level of health literacy using three 5-point screening questions[43] (Cronbach’s a = 0.59; range summed scores, 3– 15)
An online randomized experiment was conducted in which participants viewed a video vignette embedded in an online survey
Summary
Disease-naıve participants were asked whether they had been treated for a disease that had required 4 or more hospital visits or bimonthly visits to their general practitioner in the past 5 years and, if so, what disease (i.e., diabetes, cardiovascular disease, disease of the lungs/airways, skin disease, or other to specify) Those indicating they had a rheumatic disease, cancer, or kidney disease were treated as patient participants. Understanding of the information about the treatment options was measured by 1) free recall of pros and cons of the 2 options[45] and 2) aspects that participants had considered in determining their preferred option, reflecting the extent to which they understood how options differed. Two independent coders (A.H.P., J.E.d.B.) coded the free recall and added aspects, and determined all final scores in consensus
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