SHARED DECISION MAKING BEHAVIOURS IN FAMILY MEDICINE RESIDENTS

Purpose: Within the context of a larger study, EXACKTE², we assessed shared decision-making (SDM)-specific behaviours in family medicine residents during routine clinical practice.

Method: EXACKTE² recruited dyads consisting of patients consulting in primary care clinics and family physicians or family medicine residents. The recruitment was performed within the academic health networks of the University of Western Ontario (London, ON) and the Université Laval (Quebec City, QC). Consultations were recorded and transcribed verbatim. Four previously raters, trained, randomly coded the transcriptions using the OPTION scale. This validated five-point scale, ranging from 0 to 4, assessed 12 specific behaviours associated with SDM. Total score was standardized out of 100. Descriptive and inferential statistics were used to evaluate the extent to which family medicine residents applied SDM-specific behaviours and to determine if correlations exist between scores and sociodemographic variables.

Result: Of 276 dyads, we recruited 152 patient-family medicine resident dyads (68 and 84, English and French speaking, respectively) in 13 clinics in London and in six family medicine units in Quebec City, resulting in a participation rate of 75% among the eligible residents. The mean global OPTION score was 24%±8%; the mean score for each of the 12 items ranged from 4% to 37%. Five behaviours out of 12 received a mean score below ‘a minimal attempt is made to exhibit the behaviour’ (<25%). These were: assessing preferred approach to receiving information, stating that there is more than one option, eliciting preferred level of involvement, indicating the need for a decision (or deferring), and exploring concerns. The behaviour with the best score was: listing the options. A positive correlation was observed between the OPTION score and the duration of consultation (r=0.20; p=0.01). No significant differences in OPTION scores were observed according to the language in which consultations were conducted and the sex of the resident after adjusting for duration of consultation. Detaining an additional academic degree was associated with lower OPTION scores, even after adjusting for the consultations’ duration and language.

Conclusion: SDM-specific behaviours are not well integrated in family medicine residents’ practices and duration of consultation appears to be a major determinant of this situation. Our results should guide educators towards developing interventions targeting behaviours essential for the integration of SDM in the context of family medicine practice.