Purpose: Shared decision making (SDM), a decision-making process jointly shared by health professionals and patients, represents a promising strategy to promote patient-centred care, evidence-base practice and health-related decisions that are informed, value-based and adhered to. Studies reporting on theory-based approaches to inform the implementation of SDM in health professions allied to medicine are utterly lacking. Therefore, the purpose of the present study was to identify dietitians’ salient beliefs regarding their adoption of SDM-specific behaviours.
Method: Participants were dietitians from the Quebec University Hospital Center. Focus groups were using a semi-structured interview guide based on the Theory of Planned Behaviour to identify dietitians’ salient beliefs regarding their adoption of two behaviours deemed essential to engage in SDM: 1) to present dietary treatment options in the context of clinical encounters with patients and 2) to help patients clarify their values and preferences when faced with dietary treatment options. More specifically, the interview guide was designed according to the following theoretical categories of salient beliefs: advantages and disadvantages of adopting the two behaviours (to evaluate attitude towards action), individuals or groups important to the participants who would approve or disapprove their adoption of the two behaviours (to evaluate subjective norm), and barriers and facilitators associated with the adoption of the two behaviours (to evaluate perception of behavioural control). Discussions were audiotaped, transcribed verbatim, coded and analysed with the N*Vivo software (version 8) by two independent assessors.
Result: Twenty-one dietitians participated in one of four focus groups. Most dietitians mentioned improved patient adherence to treatment to be an advantage of adopting both behaviours. Dietitians identified patients, physicians and multidisciplinary team as normative referents that would approve or disapprove their adoption of both behaviours. The most often reported barriers and facilitators for both behaviours were related to the characteristics of patients, clinical situation and lack of time.
Conclusion: Dietitians’ salient beliefs elicited in this study provide the first theoretical basis to inform the development of a survey questionnaire that will quantitatively assess dietitians’ intention and psychosocial determinants to engage in SDM-specific behaviours. Future steps include developing the salient beliefs-based questionnaire and surveying a representative sample of dietitians from the Province of Québec to gather quantitative data that will be useful for designing SDM implementation studies in the field of nutrition.
See more of: The 32nd Annual Meeting of the Society for Medical Decision Making