Stine R Søndergaard1, Poul H Madsen2, Ole Hilberg3, Troels Bechmann4, Erik Jakobsen5, Karina M Jensen6, Karina Olling6, Karina D Steffensen7. 1. Department of Oncology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark; Center for Shared Decision Making, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark; Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark. Electronic address: stine.rauff.sondergaard@rsyd.dk. 2. Department of Internal Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark. 3. Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; Department of Internal Medicine, The Lung Cancer Diagnostic Organization, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark. 4. Department of Oncology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark; Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark. 5. Department of Oncology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark. 6. Center for Shared Decision Making, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark. 7. Department of Oncology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark; Center for Shared Decision Making, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark; Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
Abstract
OBJECTIVE: Concerns of increased time consumption and of the impact on clinical decisions may restrain doctors from shared decision making (SDM). This paper evaluates consultation length and decisions made when using an in-consult patient decision aid (PtDA). METHODS: This prospective cohort study compared an unexposed cohort with a cohort exposed to SDM and a PtDA in two preference-sensitive decision situations: invasive lung cancer diagnostics and adjuvant treatment for early breast cancer. Outcome measures were consultation length and decisions made. RESULTS: The study included 261 consultations, 115 were in the SDM-exposed cohort. Consultations were inconsiderably longer in the SDM cohort; 2 min, 11 s (p = 0.2217) for lung cancer diagnostics and 3 min, 57 s (p = 0.1128) for adjuvant breast cancer treatment. In lung cancer diagnostics, consultation length became more uniform and decisions tended to become conservative after introduction of SDM. For adjuvant breast cancer, slightly more patients in the SDM cohort chose to decline treatment. CONCLUSION: Shared decision making did not take significantly longer time and led to slightly more conservative decisions. PRACTICE IMPLICATIONS: SDM may be implemented without considerable impact on consultation length. The impact on clinical decisions depends mainly on the clinical situation.
OBJECTIVE: Concerns of increased time consumption and of the impact on clinical decisions may restrain doctors from shared decision making (SDM). This paper evaluates consultation length and decisions made when using an in-consult patient decision aid (PtDA). METHODS: This prospective cohort study compared an unexposed cohort with a cohort exposed to SDM and a PtDA in two preference-sensitive decision situations: invasive lung cancer diagnostics and adjuvant treatment for early breast cancer. Outcome measures were consultation length and decisions made. RESULTS: The study included 261 consultations, 115 were in the SDM-exposed cohort. Consultations were inconsiderably longer in the SDM cohort; 2 min, 11 s (p = 0.2217) for lung cancer diagnostics and 3 min, 57 s (p = 0.1128) for adjuvant breast cancer treatment. In lung cancer diagnostics, consultation length became more uniform and decisions tended to become conservative after introduction of SDM. For adjuvant breast cancer, slightly more patients in the SDM cohort chose to decline treatment. CONCLUSION: Shared decision making did not take significantly longer time and led to slightly more conservative decisions. PRACTICE IMPLICATIONS: SDM may be implemented without considerable impact on consultation length. The impact on clinical decisions depends mainly on the clinical situation.