Dillon EC, Stults CD, Wilson C, Chuang J, Meehan A, Li M, Elwyn G, Frosch DL, Yu E, Tai-Seale M., Patient Educ Couns. pii: S0738-3991(17)30254-9. doi: 10.1016/j.pec.2017.04.020. [Epub ahead of print], 2017 May 01
OBJECTIVE: Evaluate interventions to enhance patient-physician communication and shared decision making (SDM).
METHODS: We used Observer OPTION5 to evaluate primary care visits within a cluster randomized controlled trial in a California delivery organization. Trial interventions included Open Communication (OpenComm), combining patient activation and physician coaching, and AskShareKnow, a patient activation tool, and were compared to a usual care arm. Scores were analyzed with descriptive statistics and generalized estimating equation analysis for 40 visits containing 200 decision topics.
RESULTS: The mean overall OPTION5 score was 26.5 out of 100 (s.d.=15.2). Compared to visits in the usual care arm, OpenComm visits had higher mean item scores (0-4 scale) for eliciting (mean=1.0 vs 0.8) and integrating patient preferences (mean=1.0 vs 0.8). OpenComm and AskShareKnow visits had higher scores for presenting options (mean=1.5, 1.5 vs 1.3). AskShareKnow visits had higher scores for discussing pros/cons (mean=1.5 vs 1.1). Lower patient education attainment was associated with lower scores.
CONCLUSIONS: OpenComm and AskShareKnow were associated with improved SDM relative to usual care.
PRACTICE IMPLICATIONS: Results suggest targeting patient and physician behaviors promotes SDM better than patient activation only. Improving SDM for less educated patients is crucial.