Ellis C Dillon1, Cheryl D Stults2, Caroline Wilson3, Judith Chuang4, Amy Meehan5, Martina Li6, Glyn Elwyn7, Dominick L Frosch8, Edward Yu9, Ming Tai-Seale10. 1. Palo Alto Medical Foundation Research Institute, Mountain View, USA. Electronic address: dillone@pamfri.org. 2. Palo Alto Medical Foundation Research Institute, Mountain View, USA. Electronic address: stultsc@pamfri.org. 3. All Native Group, Alexandria, VA, USA. Electronic address: cwilson@allnativegroup.com. 4. Palo Alto Medical Foundation Research Institute, Mountain View, USA. Electronic address: chuangj@pamfri.org. 5. Palo Alto Medical Foundation Research Institute, Mountain View, USA. Electronic address: meehana@pamfri.org. 6. Palo Alto Medical Foundation Research Institute, Mountain View, USA. Electronic address: lim@pamfri.org. 7. The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Hanover, USA. Electronic address: glynelwyn@gmail.com. 8. Palo Alto Medical Foundation Research Institute, Mountain View, USA; Department of Medicine, University of California, Los Angeles, USA. Electronic address: froschd@pamfri.org. 9. Palo Alto Medical Foundation, Mountain View, USA. Electronic address: yue2@pamf.org. 10. Palo Alto Medical Foundation Research Institute, Mountain View, USA. Electronic address: tai-sealeM@pamfri.org.
Abstract
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.
RCT Entities:
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.
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