DO PRIMARY CARE CLINICIANS ASK PATIENTS WHAT MATTERS TO THEM? AN OBSERVATIONAL STUDY IN 5 FAMILY MEDICINE CLINICS

Purpose: To describe the practice of values clarification and preference elicitation in primary care, including which factors are associated with whether or not patients feel that clinicians ask what is important to them.

Methods: We invited clinicians and patients in five university-affiliated family medicine clinics across Quebec to participate in an observational study. Participating clinicians completed self-administered questionnaires about their age, gender, clinical background, years of practice and decision-making style preference (clinician-led, shared, or patient-led). People seeing participating clinicians as patients or primary caregivers of minors (hereby described together as ‘patients’) were eligible to participate if they could complete questionnaires in French or English. Patients completed two self-administered questionnaires: one prior to clinical consultations with socio-demographic questions; the second immediately after their consultation with questions about their decision-making style preferences and their perceptions of the visit. Consultations were audio-recorded. We conducted a multilevel (generalized linear mixed model) regression analysis on patients’ perceptions of having been asked what was important to them with independent variables at the level of each patient (age; gender; education; decision-making style preference), clinician (age; gender; clinical background; decision-making style preference) and patient-clinician relationship (whether or not the patient had previously consulted the clinician.)

Results: Of those invited, 73/96 clinicians (76%) and 262/384 patients (68%) participated. Clinicians were 53% physicians, 37% residents, 9% nurses, 1% other (nutritionist). Patients were 76% women with median age 39 (range 16-82) and a broad range of educational attainment. Most patients (87%) and clinicians (97%) preferred patient-led or shared decision making. Among patients who reported a decision being made (151/261=58%), 66% (100/151) reported being asked about what was important to them. Older patients were more likely to perceive having been asked what was important to them: OR=1.03, 95%CI (1.01, 1.05), p=.001. Patients who saw a nurse were less likely to report having been asked what was important to them compared to those who saw a physician: OR=0.11, 95%CI (0.02,0.69), p=.02. There were no other significant predictors.

Conclusions: Patients and primary care clinicians alike want patients to participate actively in health decisions but the extent to which patients’ values and preferences are solicited varies. Further research will include a content analysis of audio recordings and a comparison between what is observed in recordings and patients’ post-visit reports.