ASSESING PATIENTS' INVOLVEMENT IN DECISION-MAKING DURING A NUTRITIONNAL CONSULTATION WITH A DIETITIAN

Purpose: Little is known about shared decision making (SDM) in diet-related healthcare and clinical practice. Therefore, our objective was to assess the extent to which dietitians involve patients in decisions about their dietary treatment.

Method: We recruited dietitians working in hospitals in the Province of Quebec (Canada). Participating dietitians were asked to identify one patient to be seen during an upcoming consultation and in which a value-sensitive, nutritional treatment decision was expected to occur. All patients consulting for a diet-related health condition were eligible to participate. We audiotaped dietitians conducting nutritional consultations with their patients and we transcribed the tapes verbatim. Three trained raters independently evaluated the content of the nutritional consultations with a coding frame based on the 12 items of the French-language version of the OPTION scale, a validated and reliable third-observer instrument designed to assess patients’ involvement by examining specific health professional behaviours. Coding was facilitated by the qualitative research software NVivo 8. We assessed internal consistency with Cronbach’s alpha and inter-rater reliability with the intraclass correlation coefficient (ICC).

Result: Of 40 dietitians eligible to participate in the study, 19 took part. All dietitians were women aged between 24 to 60 years old (mean age 39.3±11.0 years).Their mean number of years in dietetic practice was 13.5±9.2. We recruited one patient per participating dietitian. Patients (mean age 40.2±25.2) were consulting for a variety of diet-related health conditions including diabetes, cardiovascular disease, and high risk pregnancy. The overall mean OPTION score was 29±8 (range=0 [no involvement] to 100 [high involvement]). Internal consistency and inter-rater reliability were both good (Cronbach’s alpha=0.938; ICC=0.65). Dietitians demonstrated the highest standard of skill for exploring patient’s expectations about how to manage the problem and the lowest for assessing the patient’s preferred approach to receiving information to assist decision making. Mean duration of consultations was 50±26min. The OPTION score was positively correlated with the duration of consultation (r=0.65,P<0.01).

Conclusion: Results indicate that dietitians’ involvement of patients in decisions about their dietary treatment is suboptimal. Interventions to increase patients’ involvement in decisions about their dietary treatment are needed and should include the training of dietitians. This study was funded by a George Bennett postdoctoral grant from the Foundation for Informed Medical Decision Making awarded to SD (FIMDM 2008-2009, grant #0108-1).