DOES ADOPTION OF CLINICAL PRACTICE GUIDELINES NEGATIVELY AFFECT ADOPTION OF SHARED DECISION MAKING IN PRACTICE?

Purpose: To investigate the ambiguity in the relationship between shared decision making (SDM) and adoption of clinical practice guidelines (CPG) by physicians.

Method: Family physicians (FPs) participating in  a two-arm pilot clustered randomized clinical trial (RCT) assessing the impact of a SDM training program on the decisions to use antibiotics for acute respiratory infection (ARI) in primary care, reported their intention to adopt SDM as well as their intention to adopt CPG.  We used path analysis to explore the relationship between both behavioral intentions at baseline (T0), after immediate exposure of one group of FPs to the SDM training program (T1) and after delayed exposure of the second group of FPs (T2).

Result: A total of 39 FPs participated to the study. The mean age of the sample was 48 ± 8 yrs and the proportion of female physicians, 51%. The mean number of years in practice was 22 ± 9, mean number of hours per week spent in clinical activities, 46 ± 12, and mean number of patients seen during a week, 109 ± 38. At T0, T1 and T2, the intention to adopt CPG was higher than the intention to adopt SDM (T0: 1.9 ± 0.8 vs 0.6 ± 1.1; T1: 2.1 ± 0.7 vs 1.1 ± 1.2; T2: and 2.0 ±0.8 vs 1.1 ±0.9 [score ranging from -3.0 to 3.0]). At T0, the intention to adopt SDM influenced positively the intention to adopt CPG while the reverse influence pattern was not statistically significant. At T1, no relationship was observed between both behavioral intentions. At T2, although there was no mutual influence between both behavioral intentions, it was observed a statistically significant strong positive correlation (r=0.86). 

Conclusion: Over the course of a pilot clustered RCT assessing the impact of a SDM training program on the decisions to use antibiotics for ARI, the intention of FPs to adopt SDM increased while the intention to adopt CPG remained constant. However, the intention of participating FPs to adopt SDM did not negatively influence their intention to adopt CPG.