USING THE OBSERVER OPTION5 MEASURE TO EVALUATE THE EFFECT OF A NOVEL “OPEN COMMUNICATION” INTERVENTION ON SHARED DECISION-MAKING IN PRIMARY CARE APPOINTMENTS

Purpose:

To analyze the impact of a novel intervention for improving patient-physician communication by evaluating how physicians engage patients in shared decision-making. 

Method:

A cluster randomized controlled trial tested two interventions at four primary care clinics of a multispecialty group practice: (1) usual care, (2) Ask 3 Questions, an existing tool encouraging patients to ask questions, (3) Open Communication, a novel intervention combining physician and patient coaching, and (4) Ask 3+Open Communication. The Open Communication intervention incorporated the “Visit Companion Booklet”, video coaching for patients, and Standardized Patient Instructor communication coaching for physicians. Of the 300 adult patients who participated, 40 visits were audio-recorded (10 per clinic). Observer OPTION⁵, a validated observer measure, was used to evaluate how physicians present options, establish a partnership with the patient, describe pros and cons of options, elicit patient preferences, and integrate patient preferences into the decision. Two qualitative researchers blinded to intervention arms jointly identified “topics” requiring decisions, scored each item, and then averaged across coders to create final scores.

   We used descriptive statistics and linear regression with cluster robust standard errors to analyze the OPTION⁵ item and final scores (scaled 0-100) for 200 topics. The models included the main effects for both interventions, their interaction, and controlled for patient demographics.

Result:

The average number of “topics” per visit coded ranged from 4.8 to 5.2 [min=1, max=13, s.d. 2.15-3.36].

   Overall, presenting options and describing pros and cons of options had the highest average scores (7.65 and 7.24). For presenting options, the coefficient on the main effect for Ask 3 was positive and statistically significant (coeff=0.90, p<0.05). The scores for Ask 3+Open Communication were significantly lower than usual care for presenting options (coeff=-.49, p<0.01) and establishing partnership (coeff=-1.3, p<0.01). There were no other statistically significant results for comparisons to usual care.

Conclusion:

While the general level of shared decision-making was low, the use of the Ask 3 prompt led to a small but significant increase in physicians presenting options to patients. No other significant improvements in other aspects of shared decision-making were present. These findings illustrate how difficult it is to change physician communication with patients, and the overall low final scores (under 30%) suggest that it is imperative to find methods to better engage patients in sharing decision-making.