Putting informed and shared decision making into practice

  1. Angela Towle PhD1,
  2. William Godolphin PhD2,
  3. Garry Grams PhD3,
  4. Amanda LaMarre MA4

Article first published online: 6 NOV 2006

DOI: 10.1111/j.1369-7625.2006.00404.x

Issue

Health Expectations

Health Expectations

Volume 9, Issue 4, pages 321–332, December 2006

Additional Information

How to Cite

Towle, A., Godolphin, W., Grams, G. and LaMarre, A. (2006), Putting informed and shared decision making into practice. Health Expectations, 9: 321–332. doi: 10.1111/j.1369-7625.2006.00404.x

Author Information

  1. 1

    Assistant Professor, Department of Medicine & Undergraduate Dean's Office, Faculty of Medicine and Division of Health Care Communication, College of Health Disciplines, The University of British Columbia

  2. 2

    Professor, Department of Pathology & Laboratory Medicine, Faculty of Medicine and Division of Health Care Communication, College of Health Disciplines, The University of British Columbia

  3. 3

    Assistant Professor, Department of Family Practice, Faculty of Medicine, The University of British Columbia

  4. 4

    Masters Student, Department of Psychology, The University of British Columbia, Vancouver, BC, Canada

*Angela Towle Department of Medicine & Undergraduate Dean's Office Faculty of Medicine The University of British Columbia 11th Floor, 2775 Laurel Street Vancouver BC Canada V5Z IM9 E-mail: atowle@interchange.ubc.ca

Publication History

  1. Issue published online: 6 NOV 2006
  2. Article first published online: 6 NOV 2006
  3. Accepted for publication 30 May 2005

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Keywords:

  • Canada;
  • family medicine;
  • patient participation;
  • physician–patient communication;
  • shared decision making

Abstract

Objective  To investigate the practice, experiences and views of motivated and trained family physicians as they attempt to implement informed and shared decision making (ISDM) in routine practice and to identify and understand the barriers they encounter.

Background  Patient involvement in decision making about their health care has been the focus of much academic activity. Although significant conceptual and experimental work has been done, ISDM rarely occurs. Physician attitudes and lack of training are identified barriers.

Design  Qualitative analysis of transcripts of consultations and key informant group interviews.

Settings and participants  Six family physicians received training in the ISDM competencies. Audiotapes of office consultations were made before and after training. Transcripts of consultations were examined to identify behavioural markers associated with each competency and the range of expression of the competencies. The physicians attended group interviews at the end of the study to explore experiences of ISDM.

Results  The physicians liked the ISDM model and thought that they should put it into practice. Evidence from transcripts indicated they were able to elicit concerns, ideas and expectations (although not about management) and agree an action plan. They did not elicit preferences for role or information. They sometimes offered choices. They had difficulty achieving full expression of any of the competencies and integrating ISDM into their script for the medical interview. The study also identified a variety of competency-specific barriers.

Conclusion  A major barrier to the practice of ISDM by motivated physicians appears to be the need to change well-established patterns of communication with patients.

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