EXACKTE2: EXPLORING DYADIC RELATIONSHIPS WITHIN PATIENT-PHYSICIAN CONSULTATIONS USING THE ACTOR-PARTNER INTERDEPENDENCE MODEL

Purpose: People involved in dyadic relationships can and often do influence each other’s thoughts, emotions and behaviors. Our objective was to explore dyadic relationships within the patient-physician consultation based on the integrated model of shared decision making (SDM) proposed by Makoul and Clayman in 2006.

Method: We carried out a cross-sectional study in 17 primary care clinics in London, Ontario, and Quebec City, Quebec, Canada. We enrolled physicians from participating clinics and one of each physician’s patients. We asked the physicians and patients to complete independently a self-administered questionnaire following the consultation. In both physicians and patients, we measured four components of the integrated model of SDM (the independent variables): i) defining/explaining the problem, presenting options and discussing pros/cons; ii) clarifying patients’ values/preferences; iii) discussing patients’ ability/self-efficacy; iv) checking/clarifying patients’ understanding. We used systematic reviews to map existing dyadic measures onto each SDM component. We also measured physician’ and patients’ personal uncertainty (the dependent variable). All scales had been validated and their dyadic potential confirmed. We then used the Actor-Partner Interdependence Model (APIM) to assess actor and partner effects within the patient-physician consultation. The actor effect occurs when a person’s score on SDM components affects that person’s score on uncertainty; the partner effect occurs when a person’s score affects his/her partner’s score on uncertainty. We applied multilevel analyses for the APIM.

Result: Of 382 eligible physicians, 274 physicians (72%) agreed to participate. Physicians’ mean age was 36.6 ± 10.7; 64% were female. Of 430 eligible patients, 276 (64%) agreed to participate. Patients’ mean age was 49.4 ± 17.7 and 69% were female. A total of 122 complete unique dyads were available for APIM analysis. We found one actor effect explaining physicians’ uncertainty (clarifying patients’ values/preferences) and three actor effects explaining patients’ uncertainty (clarifying patients’ values/preferences; discussing patients’ ability/self-efficacy; checking/clarifying patients’ understanding). We found no partner effects.

Conclusion:  The APIM reveals no partner effects for components of the integrated model of SDM practiced during the patient-physician consultation. Therefore, independently intervening on each member of the dyad to reduce his/her personal uncertainty as observed through the actor effects does not risk increasing the other member’s uncertainty.