Sydney E Philpott1, Holly O Witteman2, Katherine M Jones3, David S Sonderman3, Anne-Sophie Julien4, Mary C Politi5. 1. Division of Public Health Sciences, Washington University in St. Louis School of Medicine, St. Louis, MO, USA. 2. Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada; Office of Education and Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada; Research Centre, CHU de Québec-Université Laval, Quebec City, Quebec, Canada. 3. Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA. 4. Research Centre, CHU de Québec-Université Laval, Quebec City, Quebec, Canada. 5. Division of Public Health Sciences, Washington University in St. Louis School of Medicine, St. Louis, MO, USA. Electronic address: mpoliti@wustl.edu.
Abstract
OBJECTIVE: We examined clinicians' attitudes, beliefs, and behavioral intentions about discussing evidence and eliciting values when patients question recommendations. METHODS: We randomized trainees to read one of three scenarios about a parent of a one-year-old: 1) overuse (parent requests antibiotics for presumed viral infection); 2) equipoise (tubes for recurrent ear infections); 3) underuse (parent hesitates about vaccination). Participants then answered survey questions. Outcomes included time spent clarifying values (primary), attitudes and beliefs about the parent (secondary). RESULTS:132 medical students and pediatric residents enrolled; 119 (90%) completed the study. There were no differences in time participants would spend clarifying values (antibiotics 26±12%; equipoise 28±11%; vaccine-hesitancy 22±11%; p=0.058). Participants in the vaccine-hesitancy group (vs. other groups) would spend less time answering questions (p=0.006). Participants in the antibiotics (vs. equipoise) group perceived the parent as difficult (p=0.0002). Those in the vaccine-hesitancy group (vs. other groups) perceived the parent as difficult, saw less value in the conversation, and had lower respect for the parent's views (all ps<0.0001). Most (76%) wanted additional training navigating these discussions. CONCLUSION: Clinicians' attitudes may impact conversations when patients question evidence-based recommendations. PRACTICE IMPLICATIONS: Clinicians should consider ways to discuss evidence and clarify patients' values to optimize health without damaging patient-clinician relationships.
RCT Entities:
OBJECTIVE: We examined clinicians' attitudes, beliefs, and behavioral intentions about discussing evidence and eliciting values when patients question recommendations. METHODS: We randomized trainees to read one of three scenarios about a parent of a one-year-old: 1) overuse (parent requests antibiotics for presumed viral infection); 2) equipoise (tubes for recurrent ear infections); 3) underuse (parent hesitates about vaccination). Participants then answered survey questions. Outcomes included time spent clarifying values (primary), attitudes and beliefs about the parent (secondary). RESULTS: 132 medical students and pediatric residents enrolled; 119 (90%) completed the study. There were no differences in time participants would spend clarifying values (antibiotics 26±12%; equipoise 28±11%; vaccine-hesitancy 22±11%; p=0.058). Participants in the vaccine-hesitancy group (vs. other groups) would spend less time answering questions (p=0.006). Participants in the antibiotics (vs. equipoise) group perceived the parent as difficult (p=0.0002). Those in the vaccine-hesitancy group (vs. other groups) perceived the parent as difficult, saw less value in the conversation, and had lower respect for the parent's views (all ps<0.0001). Most (76%) wanted additional training navigating these discussions. CONCLUSION: Clinicians' attitudes may impact conversations when patients question evidence-based recommendations. PRACTICE IMPLICATIONS: Clinicians should consider ways to discuss evidence and clarify patients' values to optimize health without damaging patient-clinician relationships.
Authors: Victoria O Olarewaju; Kristen Jafflin; Michael J Deml; Clara Zimmermann; Joanna Sonderegger; Thierry Preda; Hanna Staub; Marek Kwiatkowski; Andrea Kloetzer; Benedikt M Huber; Sonja Merten; Philip E Tarr Journal: Hum Vaccin Immunother Date: 2021-03-24 Impact factor: 3.452