WHAT DO HEALTH CARE PROVIDERS THINK ABOUT SHARED DECISION MAKING?

Purpose: To assess primary care providers’ (PCPs) and specialists’ perspectives on shared decision making. Specifically, we focused on their opinions about two main factors, informing patients and discussing patients’ preferences.

Method: Providers identified through the American Medical Association master file were surveyed about one of four common decisions: colon cancer screening (CRC), herniated disc (HD), menopause (Meno), or depression (Dep).  We examined providers’ responses to items about the extent to which they inform patients and discuss patients’ preferences, their use of educational materials, and whether they differed by condition or by training (specialists vs. PCP).

Result: Overall, 436/737 (59%) of providers responded across the four topics, including 182 PCPs and 254 specialists. The respondents were on average 52 years old (SD 9.2), white (73%), male (68%), and had been in practice 21 years (SD 9.5). Specialists had higher annual patient volume, (median 530 vs. 301) and were more likely to be white (79% vs. 70%, p=0.02) compared to PCPs. Overall, 58% of providers reported using educational materials for these conditions, with specialists reporting higher use than PCPs (73% vs. 39% p<0.001).  Almost all providers felt it was very important for their patients to be informed (94% vs. 94.5%, p=.58). Specialists were more likely to report that their patients were extremely or very well informed compared to PCPs (73% vs. 47%, p=<.001). Almost all providers (93%) felt that it was extremely or very important to discuss patients’ treatment preferences before a decision is made. Both specialists and PCPs report having such discussions often (98% and 93%, p=0.007). Providers’ use of educational materials varied by condition (69% HD, 64% Meno, 56% CRC, 47% Dep, p=0.008). More HD and CRC providers reported their patients were extremely or very well informed (80% HD and 70% CRC vs. 53% Dep and 50% Meno,  p <0.001). Fewer CRC providers thought it was important to discuss patients’ preferences (98% HD, 95% Dep, 95% Meno vs. 84% CRC p <.0001).

Conclusion: Providers feel strongly about the importance of key components of shared decision making. Providers had mixed reports about how well informed their patients were, with specialists being more confident than primary care providers. Virtually all providers reported that they always discuss patients’ preferences for these decisions.