Abstract
BackgroundDECISION + 2, a training program for physicians, is designed to implement shared decision making (SDM) in the context of antibiotics use for acute respiratory tract infections (ARTIs). We evaluated the impact of DECISION + 2 on SDM implementation as assessed by patients and physicians, and on physicians’ intention to engage in SDM.MethodsFrom 2010 to 2011, a multi-center, two-arm, parallel randomized clustered trial appraised the effects of DECISION + 2 on the decision to use antibiotics for patients consulting for ARTIs. We randomized 12 family practice teaching units (FPTUs) to either DECISION + 2 or usual care. After the consultation, both physicians and patients independently completed questionnaires based on the D-Option scale regarding SDM behaviors during the consultation. Patients also answered items assessing the role they assumed during the consultation (active/collaborative/passive). Before and after the intervention, physicians completed a questionnaire based on the Theory of Planned Behavior to measure their intention to engage in SDM. To account for the cluster design, we used generalized estimating equations and generalized linear mixed models to assess the impact of DECISION + 2 on the outcomes of interest.ResultsA total of 270 physicians (66% women) participated in the study. After DECISION + 2, patients’ D-Option scores were 80.1 ± 1.1 out of 100 in the intervention group and 74.9 ± 1.1 in the control group (p = 0.001). Physicians’ D-Option scores were 79.7 ± 1.8 in the intervention group and 76.3 ± 1.9 in the control group (p = 0.2). However, subgroup analyses showed that teacher physicians D-Option scores were 79.7 ± 1.5 and 73.0 ± 1.4 respectively (p = 0.001). More patients reported assuming an active or collaborative role in the intervention group (67.1%), than in the control group (49.2%) (p = 0.04). There was a significant relation between patients’ and physicians’ D-Option scores (p < 0.01) and also between patient-reported assumed roles and both D-Option scores (as assessed by patients, p < 0.01; and physicians, p = 0.01). DECISION + 2 had no impact on the intention of physicians to engage in SDM.ConclusionDECISION + 2 positively influenced SDM behaviors as assessed by patients and teacher physicians. Physicians’ intention to engage in SDM was not affected by DECISION + 2.Trial registrationClinicalTrials.gov trials register no. NCT01116076.
Highlights
DECISION + 2, a training program for physicians, is designed to implement shared decision making (SDM) in the context of antibiotics use for acute respiratory tract infections (ARTIs)
Results of attempts to improve the clinical decision making process regarding the use of antibiotics for ARTIs have been weakly conclusive, and interventions to reduce the use of antibiotics have mostly shown only modest improvements [2,3]
Our study demonstrated a favorable impact of DECISION + 2 on SDM implementation in clinical practice as assessed by patients and teacher physicians using three measures
Summary
DECISION + 2, a training program for physicians, is designed to implement shared decision making (SDM) in the context of antibiotics use for acute respiratory tract infections (ARTIs). Scientific uncertainty about use of antibiotics as well as a failure to take into account the perspectives of both parties (patient as well as health professional), each with their own kind of expertise, may explain these results. In this clinical context, shared decision making (SDM) is an interesting pathway in the pursuit of optimal decisions. The role the patient assumes that best matches the SDM paradigm is the collaborative role, though moving patients from a passive to a more active role may be considered an important step toward SDM [9]
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