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Patient-physician agreement on the content of CHD prevention discussions
Lindy Behrend1, Hossein Maymani, Megan Diehl
1Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC 27599, USA. lindy_behrend@med.unc.edu
Insights
Patient and physician agreement on coronary heart disease (CHD) prevention discussions varied. While they agreed on whether CHD was discussed, disagreements were noted on discussion content and patient involvement in decision-making.
Area of Science:
- Cardiology
- Health Services Research
- Medical Communication
Background:
- Patient-physician agreement on clinical discussion content and outcomes is not well understood.
- Shared understanding is crucial for optimizing decision-making and patient care.
Purpose of the Study:
- To assess patient and physician agreement on the content and outcomes of coronary heart disease (CHD) prevention discussions.
Main Methods:
- A cross-sectional survey was conducted within a randomized CHD prevention study at a university internal medicine clinic.
- 157 patients and 24 physicians completed surveys post-visit regarding discussion content, decision-making, and final decisions.
- Audio recordings of 20 visits were used for comparison, with analyses including percent agreement and Cohen's kappas.
Main Results:
- Agreement was high on whether CHD was discussed (83%, kappa=0.55).
- Agreement on discussion content (pros/cons) was lower (53%, kappa=0.15), but higher on physician recommendations (73%, kappa=0.44).
- Agreement was substantial for medication decisions (78%, kappa=0.58) and lifestyle changes (69%, kappa=0.38), but low for decision-making involvement (43%, kappa=0.13).
- Audio recordings indicated low agreement between self-reports and transcribed discussions.
Conclusions:
- Discrepancies in patient-physician communication and shared decision-making regarding CHD prevention are common.
- Further research is needed to understand the prevalence, impact on outcomes, and the balance between subjective experience and objective steps in shared decision-making.
Background:
Little is known about agreement between patients and physicians on content and outcomes of clinical discussions. A common perception of content and outcomes may be desirable to optimize decision making and clinical care.
Objective:
To determine patient-physician agreement on content and outcomes of coronary heart disease (CHD) prevention discussions.
Design:
Cross-sectional survey nested within a randomized CHD prevention study.
Setting And Participants:
University internal medicine clinic; 24 physicians and 157 patients.
Methods:
Following one clinic visit, we surveyed patients and physicians on discussion content, decision making and final decisions about CHD prevention. For comparison, we audio-recorded, transcribed and coded 20 patient-physician visits. We calculated percent agreement between patient/physician reports, patient/transcription reports and physician/transcription reports. We calculated Cohen's kappas to compare patient/physician perspectives.
Results:
Patients and physicians agreed on whether CHD was discussed in 130 visits (83%; kappa = 0.55; 95% CI 0.40-0.70). When discussions occurred, they agreed about discussion content (pros versus cons) in 53% of visits (kappa = 0.15; 95% CI -0.01-0.30) and physicians' recommendations in 73% (kappa = 0.44; 95% CI 0.28-0.66). Patients and physicians agreed on final decisions to take medication in 78% (kappa = 0.58; 95% CI 0.45-0.71) and change lifestyle in 69% (kappa = 0.38; 95% CI 0.24-0.53). They agreed less often, 43% (kappa = 0.13; 95% CI -0.11-0.37) about degree of involvement in decision making. Audio-recorded results were similar, but showed very low agreement between transcripts and patients' and physicians' self-report on discussion content and decision making.
Conclusions:
Disagreements about clinical discussions and decision making may be common. Future work is needed to determine: how widespread such agreements are; whether they impact clinical outcomes; and the relative importance of the subjective experience versus objective steps of shared decision making.
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