Assessing the Implementation of Shared Decision-Making in Primary Care: A Study With Unannounced Standardized...

Area of Science:

• Medical Education
• Clinical Communication
• Health Behavior Research

Background:

• Shared decision-making (SDM) is a cornerstone of patient-centered care, recommended by clinical guidelines.
• However, consistent application of SDM by clinicians across diverse clinical scenarios remains a challenge.
• The influence of specific clinical topics on SDM practice is not well understood.

Purpose of the Study:

• To investigate how the clinical topic influences resident physicians' application of shared decision-making (SDM).
• To compare SDM engagement in discussions about gastroesophageal reflux disease (GERD) versus smoking cessation.

Main Methods:

• Unannounced standardized patients (USPs) simulated new patient visits for GERD and smoking cessation.
• Resident physicians' interactions were audio-recorded and assessed using the Observer OPTION-5 tool for SDM quality.

Main Results:

• SDM scores were significantly higher during smoking cessation discussions compared to GERD management.
• Residents more consistently incorporated patient preferences in smoking cessation discussions.
• Conversely, residents provided more information during GERD management consultations.

Conclusions:

• Physician SDM behaviors appear to be adapted based on the clinical context, demonstrating topic-dependent application.
• Educational strategies are needed to address this variability and ensure balanced SDM implementation for both routine and behaviorally complex issues.