Opportunities for addressing gaps in primary care shared decision-making with technology : a mixed-methods needs assessment

© The Author(s) 2018. Published by Oxford University Press on behalf of the American Medical Informatics Association..

OBJECTIVES: To analyze current practices in shared decision-making (SDM) in primary care and perform a needs assessment for the role of information technology (IT) interventions.

MATERIALS AND METHODS: A mixed-methods study was conducted in three phases: (1) ethnographic observation of clinical encounters, (2) patient interviews, and (3) physician interviews. SDM was measured using the validated OPTION scale. Semistructured interviews followed an interview guide (developed by our multidisciplinary team) informed by the Traditional Decision Conflict Scale and Shared Decision Making Questionnaire. Field notes were independently coded and analyzed by two reviewers in Dedoose.

RESULTS: Twenty-four patient encounters were observed in 3 diverse practices with an average OPTION score of 57.2 (0-100 scale; 95% confidence interval [CI], 51.8-62.6). Twenty-two patient and 8 physician interviews were conducted until thematic saturation was achieved. Cohen's kappa, measuring coder agreement, was 0.42. Patient domains were: establishing trust, influence of others, flexibility, frustrations, values, and preferences. Physician domains included frustrations, technology (concerns, existing use, and desires), and decision making (current methods used, challenges, and patients' understanding).

DISCUSSION: Given low SDM observed, multiple opportunities for technology to enhance SDM exist based on specific OPTION items that received lower scores, including: (1) checking the patient's preferred information format, (2) asking the patient's preferred level of involvement in decision making, and (3) providing an opportunity for deferring a decision. Based on data from interviews, patients and physicians value information exchange and are open to technologies that enhance communication of care options.

CONCLUSION: Future primary care IT platforms should prioritize the 3 quantitative gaps identified to improve physician-patient communication and relationships. Additionally, SDM tools should seek to standardize common workflow steps across decisions and focus on barriers to increasing adoption of effective SDM tools into routine primary care.

Medienart:	E-Artikel

Erscheinungsjahr:	2019
Erschienen:	2019

Enthalten in:	Zur Gesamtaufnahme - volume:2
Enthalten in:	JAMIA open - 2(2019), 4 vom: 31. Dez., Seite 447-455

Sprache:	Englisch

Beteiligte Personen:	Misra, Anjali J [VerfasserIn] Ong, Shawn Y [VerfasserIn] Gokhale, Arjun [VerfasserIn] Khan, Sameer [VerfasserIn] Melnick, Edward R [VerfasserIn]

Links:	Volltext

Themen:	Decision making Journal Article Medical informatics Needs assessment Physician–patient relations Primary health care

Anmerkungen:	Date Revised 12.04.2022 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE

doi:	10.1093/jamiaopen/ooz027

funding:
Förderinstitution / Projekttitel:

PPN (Katalog-ID):	NLM306203650