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Putting informed and shared decision making into practice.

Angela Towle1, William Godolphin, Garry Grams

  • 1Department of Medicine & Undergraduate Dean's Office, Faculty of Medicine and Division of Health Care Communication, College of Health Disciplines, The University of British Columbia, Vancouver, BC, Canada. atowle@interchange.ubc.ca

Health Expectations : an International Journal of Public Participation in Health Care and Health Policy
|November 7, 2006
PubMed
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Motivated family physicians found implementing informed and shared decision making (ISDM) challenging due to ingrained communication patterns. Overcoming these barriers requires significant changes in physician-patient interaction for effective ISDM.

Area of Science:

  • Medical Communication
  • Health Services Research
  • Patient-Centered Care

Background:

  • Patient involvement in healthcare decisions is widely discussed but seldom implemented.
  • Physician attitudes and inadequate training are significant barriers to informed and shared decision making (ISDM).

Purpose of the Study:

  • To explore how trained family physicians practice informed and shared decision making (ISDM).
  • To identify barriers encountered by physicians implementing ISDM in routine practice.

Main Methods:

  • Qualitative analysis of consultation transcripts and group interviews.
  • Trained family physicians' consultations were recorded and analyzed before and after training.

Main Results:

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  • Physicians supported the ISDM model but struggled with full implementation.
  • Eliciting patient concerns and agreeing on action plans were partially successful; preferences and role clarity were not.
  • Integrating ISDM into standard medical interviews and overcoming specific competency barriers proved difficult.

    • Conclusions:

    • A primary obstacle to ISDM is the deeply ingrained communication habits of physicians.
    • Changing established communication patterns is crucial for successful ISDM implementation.