Shared decision-making performance of general practice residents: an observational study combining observer, resident, and patient perspectives

Family Practice, vol. 41, pp. 50–59

Abstract

BACKGROUND: Shared decision making (SDM) is considered fundamental to person-centred care. However, applying SDM may be a challenge for residents in general practice, since it is a complex competence that requires the integration of knowledge and skills from several competency domains. OBJECTIVE: To support learning of SDM during medical residency, we aimed to gain insight in Dutch residents' observed and perceived SDM performance in general practice. METHODS: We evaluated residents' SDM performance from an observer, resident, and patient perspective. Consultations of first- and third-year residents were recorded. Trained observers used the validated Observing Patient Involvement (OPTION5) scale to assess observed SDM performance of residents in 98 actual recorded consultations. Perceived SDM performance was evaluated by residents and patients completing validated SDM questionnaires, supplemented with questions about (the context of) the consultation and perceived relevance of SDM immediately after the consultation. The data were analysed using descriptive statistics (mean, SD, minimums, and maximums) and explorative bivariate analyses. RESULTS: The residents' observed mean SDM performance was 19.1 (range, 0-100, SD = 10.9), mean resident self-reported SDM performance was 56.9 (range, 0-100, SD = 18.5), and mean patient-reported SDM performance was 73.3 (range, 0-100, SD = 26.8). We found a significant and positive correlation between observed SDM performance and residents' perceived relevance of SDM for the consultation (t = 4.571, P ≤ 0.001) and the duration of the consultation (r = 0.390, P ≤ 0.001). CONCLUSIONS: This study showed that there is room for increasing awareness of the potential incongruence between observed and perceived SDM performance during medical residency, in order to facilitate the implementation of SDM in clinical practice.

Authors 12

1. Anouk Baghus corresponding

   Maastricht University · Care and Public Health Research Institute

   Affiliation as printed

   Department of Family Medicine, Care and Public Health Research Institute, Maastricht University , Maastricht , The Netherlands

2. Esther Giroldi

   Maastricht University · Care and Public Health Research Institute

   Affiliation as printed

   Department of Educational Development and Research, School of Professional Education, Maastricht University , Maastricht , The Netherlands

   Department of Family Medicine, Care and Public Health Research Institute, Maastricht University , Maastricht , The Netherlands

3. Jasper van Geel

   Maastricht University · Care and Public Health Research Institute

   Affiliation as printed

   Department of Family Medicine, Care and Public Health Research Institute, Maastricht University , Maastricht , The Netherlands

4. Arthur Leferink

   Maastricht University · Care and Public Health Research Institute

   Affiliation as printed

   Department of Family Medicine, Care and Public Health Research Institute, Maastricht University , Maastricht , The Netherlands

5. Marjolein H. J. van de Pol

   Radboud University Nijmegen · Radboud University Medical Center

   Affiliation as printed

   Department of Primary and Community Care, Radboud University Medical Center , Nijmegen , The Netherlands

6. Ariëtte Sanders

   University Medical Center Utrecht

   Affiliation as printed

   Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht , Utrecht , The Netherlands

7. Patrick W. Dielissen

   Radboud University Nijmegen · Radboud University Medical Center

   Affiliation as printed

   Department of Primary and Community Care, Radboud University Medical Center , Nijmegen , The Netherlands

8. Isabella Bisschop Aachen Department of Public Health and Primary Care

   Leiden University Medical Center

   Affiliation as printed

   Department of Public Health and Primary Care, Leiden University Medical Center , Leiden , The Netherlands

9. Arwen H. Pieterse Aachen Medical Decision Making Department of Biomedical Data Sciences

   Leiden University Medical Center

   Affiliation as printed

   Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center , Leiden , The Netherlands

10. Jean W. M. Muris

    Maastricht University · Care and Public Health Research Institute

    Affiliation as printed

    Department of Family Medicine, Care and Public Health Research Institute, Maastricht University , Maastricht , The Netherlands

11. Angelique A. Timmerman

    Maastricht University · Care and Public Health Research Institute

    Affiliation as printed

    Department of Family Medicine, Care and Public Health Research Institute, Maastricht University , Maastricht , The Netherlands

12. Trudy van der Weijden

    Maastricht University · Care and Public Health Research Institute

    Affiliation as printed

    Department of Family Medicine, Care and Public Health Research Institute, Maastricht University , Maastricht , The Netherlands