Informed decision making in outpatient practice: time to get back to basics

Area of Science:

• Clinical Decision Making
• Patient Engagement
• Medical Communication

Background:

• Growing emphasis on patient-centered care and shared decision-making (SDM) in clinical practice.
• Limited understanding of how physicians implement SDM in everyday office settings.
• Need to assess the extent of patient involvement in routine clinical encounters.

Purpose of the Study:

• To evaluate the completeness and nature of informed decision-making processes.
• To compare these processes between primary care physicians and surgeons.
• To analyze decision-making in routine office visits.

Main Methods:

• Cross-sectional study involving 1057 audiotaped office visits from 59 primary care physicians and 65 surgeons.
• Analysis of 3552 clinical decisions using criteria adapted to decision complexity (basic, intermediate, complex).
• Evaluation focused on elements of informed decision-making, such as discussing interventions and assessing patient understanding.

Main Results:

• Only 9.0% of all clinical decisions met the criteria for complete informed decision-making.
• Completeness varied by complexity: 17.2% for basic, 0% for intermediate, and 0.5% for complex decisions.
• Discussion of intervention nature was common (71%), but assessment of patient understanding was rare (1.5%).

Conclusions:

• Informed decision-making in routine office practice is frequently incomplete for both primary care physicians and surgeons.
• Deficiencies persist even when decision-making criteria are adjusted for complexity.
• There is a clear need to implement strategies that enhance informed decision-making in clinical practice.