Shared decision-making in general practice: an observational study comparing 2007 with 2015.

Abstract

Shared decision-making (SDM) is, largely, espoused as the preferred model for making decisions in everyday health care. Studies exploring the application of SDM in primary care practice are still lacking. This study explores how GPs involve their patients in decision-making, if application of SDM has increased over time (2007-15), and what factors are associated with it. We investigated the application of SDM by Dutch GPs by analysing a random set of real-life video-recorded consultations collected in 2007 (n = 50) and 2015 (n = 50). SDM was assessed by observing patient involvement in decision making (OPTION), a reliable and valid instrument measuring the extent to which clinicians involve patients in decision-making by coding 12 behavioural items. In addition, GPs and patients completed questionnaires about their background characteristics. The potential determinants for application of SDM by Dutch GPs (including year of measurement, sex and age of patients and GPs, the nature of complaints, consultation duration and the type of decision discussed) were analysed using multilevel analysis [with patients (Level 1) nested within GPs (Level 2)]. In 2015, GPs applied SDM more often compared with 2007 according to OPTION. In consultations with older patients, there is less application of SDM by GPs. Although application of SDM by Dutch GPs has increased, low overall SDM scores still leave room for improvement. GPs should elicit the patient's preferred role in the decision-making process at any time, in particular in consultations with older patients.