Decision-making in primary care: outcomes from a study using patient scenarios


Maxine Offredy, Faculty of Health and Human Sciences, University of Hertfordshire, College Lane, Hatfield, Hertfordshire AL10 9AB, UK. E-mail:


Background.  Various documents emphasize the importance of new roles and new ways of working to modernise delivery of health service and improve the public's health. In particular nurse practitioners are seen as crucial in the modernization process.

Aim.  This paper reports the outcomes of a study conducted in 1998 to ascertain the differences, if any, in the decision-making processes of nurse practitioners and general practitioners for diagnosis and treatment when given the same patient scenarios.

Methods.  Information processing theory together with ‘think aloud’ approach were used to understand the cognitive processes of the 22 participants, 11 general practitioners and 11 nurse practitioners, in the study. A reference model was developed for each of the six scenarios of the study; three medical photographs were also used. The data were analysed using NUD*IST computer software.

Results.  The outcomes of each scenario are presented and comparisons are made with general practitioners. The results show that there were more similarities than differences in the decision-making processes of the two groups. Hypothesis evaluation appears to be the critical component in the decision-making process. Explanations given by the two groups at the end of their ‘think aloud’ procedure justify their diagnoses and treatment/management plans.

Conclusions.  The research adds to existing evidence that encourages health care providers to use nurse practitioners more flexibly and to develop service-based approaches to the delivery of health care as set down in government policies. It also adds to the body of literature using information processing theory because it demonstrates that the two groups use similar decision-making processes to arrive at similar diagnoses and treatment options.