Abstract
BackgroundAt the crux of patient centred care is Shared Decision Making (SDM), which benefits patient and practitioner. Despite external pressures, studies indicate that SDM remains poorly practised across a variety of healthcare professions. The degree of SDM engagement within United Kingdom osteopathic undergraduate teaching clinics is currently unknown.MethodsIn 2014 we used the reliable and validated OPTION-12 (O12) instrument to calculate a score that reflected the degree of SDM utility in one United Kingdom Osteopathic Educational Institute’s teaching clinic. We also aimed to compare these scores with those previously obtained for physiotherapists working within the United Kingdom’s National Health Service. Student-patient initial and follow-up encounters were audio recorded, transcribed and scored using the O12. Comparisons between the following O12 scores were performed: the Osteopathic Educational Institute’s 4th and 3rd year students; the Osteopathic Educational Institute’s student’s initial and follow-up patient encounters; the Osteopathic Educational Institute’s students and National Health Service physiotherapists.ResultsWe analysed 35.5 h of transcribed data from 30 student-patient encounters (7 initial: 23 follow-up). An O12 score of 0.6% (range 0–10.4%) was calculated. No significant differences were found between year groups or encounter types. Significant differences were found compared to National Health Service physiotherapist (score = 24.4%): (U = 144, z = 4.25, p < 0.0005); although both scores are below the 60% threshold for competent SDM behaviour.ConclusionsUndergraduate osteopaths did not appear to engage in competent SDM behaviours, implying traditional and paternalistic styles of decision making that align with results from other manual therapy professions. Students in this study did not practise competent SDM behaviours. Effective educational strategies are required to ensure SDM behaviours reach competent levels.
Highlights
At the crux of patient centred care is Shared Decision Making (SDM), which benefits patient and practitioner
Ethics approval was obtained from the Osteopathic Educational Institute’s research ethics committee and we captured SDM behaviour using the OPTION-12 (Observing Patient Involvement) scale, a previously validated instrument [31]. This reliable instrument measures the prevalence of practitioner SDM competencies captured within the verbal communications that occur during a patient-practitioner interaction
Elwyn et al (2005) recommended that a total O12 score of 60% should be considered the threshold for meaningful competence of SDM [31]
Summary
At the crux of patient centred care is Shared Decision Making (SDM), which benefits patient and practitioner. Shared Decision Making (SDM) has been defined as “...an approach where clinicians and patients make decisions together using the best available evidence” [1]. An ethical imperative is found at the heart of patient centred care, a paradigm in which clinicians and patients work together using best available evidence to agree a fully informed plan for that patient’s treatment or care [2]. The process requires equal collaboration of both parties, with patients actively encouraged to deliberate on information presented to them and to communicate their personal preferences to the clinician [3]. SDM has been the subject of ongoing discussion, research and policy initiatives across the developed world [7]
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