ADOPTING CLINICAL PRACTICE GUIDELINES NEGATIVELY IMPACT SHARING DECISIONS WITH PATIENTS BUT TRAINING HEALTH PROFESSIONALS IN SDM CANCELS THIS IMPACT

Purpose: Optimal clinical decisions combine evidence-based medicine with patient centered care. In this study, we aimed to assess the association between physicians’ intention to engage in shared decision-making (SDM) and their intention to adopt Clinical Practice Guidelines (CPG).

Method: We performed a clustered randomized trial in nine family practice teaching units in Quebec, Canada, to estimate the impact of a SDM training program targeting family physicians about antibiotics prescription for acute upper respiratory tract infections, the DECISION+2 trial. Using the Theory of Planned Behavior (TPB), we collected data on secondary outcomes: intention, attitude, social norm and perception of behavioural control regarding adoption of SDM and CPG; and measured physicians`socioeconomic status at baseline (before the intervention) and post-intervention. We conducted separate structural equations modeling with path analysis at baseline and post-intervention using the maximum likelihood method and the variance-covariance matrix. Goodness fit indices encompassed the chi-square statistic, the comparative fit index and the root mean square error of approximation.

Result: We enrolled 250 physicians at baseline and 270 post-intervention, and 519 completed questionnaires. At baseline, 51.2% were family physicians and 51.2% were residents. Because of missing values, we analyzed 244 responses before and 236 after the intervention. All fit indices indicated good adjustment of both models. At baseline, we observed a meaningful standardized negative effect of physicians` intention to adopt CPG on their intention to adopt SDM (β= -0.21, P=0.019). Physicians` intention to adopt SDM did not significantly influence their intention to adopt CPG (β= -0.02, P=0.39). At post-intervention, we observed a simultaneous negative effect between the two behaviors. However, these associations were not statistically significant.

Conclusion: Before a SDM training program, adopting CPG did negatively affect physicians’ intention to engage in SDM while physicians` intention to adopt SDM did not significantly influence their intention to adopt CPG. However, after a SDM training program, adopting CPG did not positively affect physicians’ intention to engage in SDM, nor did engaging in SDM significantly impact their intention to adopt CPG. Therefore, in order to encourage both evidence-based medicine and patient centered care, SDM training programs should be encouraged.