Shared decision making and antibiotic benefit-harm conversations: an observational study of consultations between general practitioners and patients with acute respiratory infections

Introduction: Antibiotic overuse for acute respiratory infections (ARIs) is a significant problem in Emergency Departments (EDs). DECISION+, a training program on shared decision making (SDM) and a decision aid for antibiotic use in ARIs, reduces patients’ use of antibiotics for ARIs in primary care, but has never been studied in the ED setting. The objectives of this study are to assess the intention of ED physicians to adopt SDM about antibiotic use in ARIs and to identify barriers and facilitators about adopting SDM and a decision aid for antibiotic use in ARIs. Methods: An adapted version of DECISION+ (1-hour seminar) was offered to physicians of two academic EDs (Quebec, Canada) in fall 2015. A validated questionnaire was administered to participants before and after the seminar. This questionnaire contains three items measuring the intention to adopt SDM using a 7-point Likert scale [ranging from 1 (very unlikely) to 7 (very likely)]. We performed descriptive analyses for demographic characteristics and a paired Wilcoxon signed-rank test to compare pre- and post-training intention to adopt SDM (α=.05). A debriefing session with the participants identified potential barriers and facilitators about implementing SDM and using a decision aid regarding antibiotic use for ARIs. Two researchers analysed the recorded audio material. Results: 41% (23/56) of eligible physicians received the intervention. 74 % of participants had already heard of SDM and 40% felt they already used SDM in their practice. The median intention to adopt SDM was 6 (IQR 5-6) before and 6 (IQR 5-6) after the seminar (P = .23). One participant did not answer the questionnaire after the seminar and his results were excluded from the comparative analysis. We identified 20 specific barriers to adopting SDM for deciding about antibiotics use for ARIs in the ED (e.g., lack of time) and 13 facilitators (e.g., public health campaign). Conclusion: ED physicians’ baseline intention to adopt SDM with patients for antibiotic use in ARIs is high. The adapted tutorial of DECISION+ did not change this intention. This could be explained by the social desirability of SDM. Further studies must be conducted to adapt DECISION+ to the ED setting and also to assess the impact of DECISION+ on the actual prescription and use of antibiotics for ARIs.

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EFFECTS OF A SHARED DECISION MAKING INTERVENTION FOR OLDER ADULTS WITH CHRONIC CONDITIONS: AN OBSERVATIONAL STUDY

Innovation in Aging ◽

10.1093/geroni/igz038.1090 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S296-S297

Author(s):

Ruth E Pel-Littel ◽

Bianca Buurman ◽

Marjolein van de Pol ◽

Linda Tulner ◽

Mirella Minkman ◽

...

Keyword(s):

Older Adults ◽

Decision Making ◽

Observational Study ◽

Shared Decision Making ◽

Chronic Conditions ◽

Decisional Conflict ◽

Future Research ◽

Multiple Chronic Conditions ◽

Shared Decision ◽

Perceived Involvement

Abstract Shared decision making (SDM) in older patients is more complex when multiple chronic conditions (MCC) have to be taken into account. The aim of this research is to explore the effect of the evidence based implementation intervention SDMMCC on (1) the preferred and perceived participation (2) decisional conflict and (3) actual SDM during consultations. 216 outpatients participated in a video observational study. The intervention existed of a SDM training for geriatricians and a preparatory tool for patients. Consultations were videotaped and coded with the OPTIONMCC. Pre- and post-consultation questionnaires were completed. Participation was measured by the Patients’ perceived Involvement in Care Scale (PICS). Decisional conflict was measured by the Decisional Conflict Scale (DCS). The patients mean age was 77 years, 56% was female. The preparatory tool was completed by 56 older adults (52%), of which 64% rated the tool as positive. The preparatory tool was used in 12% of the consultations. The mean overall OPTIONMCC score showed no significant changes on the level of SDM(39.3 vs 39.3 P0.98), however there were significant improvements on discussing goals and options on sub-items of the scale. There were no significant differences found in the match on preferred and perceived participation (86.5% vs 85.0% P 0.595) or in decisional conflict (22.7 vs 22.9 P0.630). The limited use of the preparatory tool could have biased the effect of the intervention. In future research more attention must be paid towards the implementation of preparatory tools, not only among patients but also among geriatricians.

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