Feasibility and acceptability of an everyday patient-centered discussion model for primary care: An exploratory,...

Primary care visits average 15 min or less, limiting physician time for engaging in detailed shared decision-making. The ZIP approach-Zeroing in on Individualized, Patient-Centered Decisions-offers a practical path to improving decisions within time constraints. This study assesses the feasibility and acceptability of the ZIP approach in facilitating patient-centered decision-making for lung cancer screening (LCS) and blood pressure (BP) management in primary care.

Multiple-methods study using audio-recorded primary care appointments and patient and physician feedback from surveys and semi-structured interviews. 23 patients who were eligible for an initial LCS (n = 4) or BP medication intensification (n = 19) and 10 primary care physicians were enrolled in a single center study in a VA medical center. Feasibility was assessed through observing duration (in minutes) for initial ZIP presentation, total conversation, completion of ZIP components, and patient-survey-based SDM measure (SDM-Q-9). Acceptability was assessed through conducting thematic analysis of patient and physician interviews.

ZIP discussions took less than 4 min. The median time for the initial ZIP presentation was 1.8 min (IQR) for LCS and 2 min (IQR) for BP conversations. Almost half of the encounters (43%; n = 9/21) had perfect ZIP fidelity scores (median = 9/10); The mean SDM-Q-9 score, reflecting patients' perceptions of the extent of SDM during the appointment, was 90.9 out of 100. Patients reported valuing personalized communication, trust, and collaborative decision-making. Physicians perceived that the SDM discussions were shorter, appreciated the tailored information and data visualizations, but suggested improvements to better align ZIP with conversational flow.

The ZIP approach is a promising method for facilitating brief, patient-centered discussions in primary care. Its high acceptability among patients and physicians suggests strong potential for improving decision quality across diverse preventive care topics.

ZIP introduces a novel framework for integrating shared decision-making into routine care by addressing longstanding implementation barriers. Future research should examine scalability across diverse settings and evaluate sustainable approaches to integrate ZIP guidance into primary care.