Abstract:
BACKGROUND:A consulting method known as 'shared decision making' (SDM) has been described and operationalized in terms of several 'competences'. One of these competences concerns the discussion of the risks and benefits of treatment or care options-'risk communication'. Few data exist on clinicians' ability to acquire skills and implement the competences of SDM or risk communication in consultations with patients. OBJECTIVE:The aims of this study were to evaluate the effects of skill development workshops for SDM and the use of risk communication aids on the process of consultations. METHODS:A cluster randomized trial with crossover was carried out with the participation of 20 recently qualified GPs in urban and rural general practices in Gwent, South Wales. A total of 747 patients with known atrial fibrillation, prostatism, menorrhagia or menopausal symptoms were invited to a consultation to review their condition or treatments. Half the consultations were randomly selected for audio-taping, of which 352 patients attended and were audio-taped successfully. After baseline, participating doctors were randomized to receive training in (i) SDM skills or (ii) the use of simple risk communication aids, using simulated patients. The alternative training was then provided for the final study phase. Patients were allocated randomly to a consultation during baseline or intervention 1 (SDM or risk communication aids) or intervention 2 phases. A randomly selected half of the consultations were audio-taped from each phase. Raters (independent, trained and blinded to study phase) assessed the audio-tapes using a validated scale to assess levels of patient involvement (OPTION: observing patient involvement), and to analyse the nature of risk information discussed. Clinicians completed questionnaires after each consultation, assessing perceived clinician-patient agreement and level of patient involvement in decisions. Multilevel modelling was carried out with the OPTION score as the dependent variable, and rater, consultation and clinician levels of data, standardized by rater within clinician. RESULTS:Following each of the interventions, the clinicians significantly increased their involvement of patients in decision making (OPTION score increased by 10.6 following risk communication training [95% confidence interval (CI) 7.9 -13.3; P < 0.001] and by 12.9 after SDM skill development (95% CI 10 -15.8, P < 0.001), a moderate effect size. The level of involvement achieved by the risk communication aids was significantly increased by the subsequent introduction of the skill development workshops (7.7 increase in OPTION score, 95% CI 3.4-12; P < 0.001). The alternative sequence (skills followed by risk communication aids) did not achieve this effect. The use of most risk information formats increased after the provision of specific risk communication aids (P < 0.001). Clinicians using the risk communication tools perceived significantly higher patient and clinician agreement on treatment (P < 0.001), patient satisfaction with information (P < 0.01), clinician satisfaction with decision (P < 0.01) and general overall satisfaction with the consultation (P < 0.001) than those who were exposed to SDM skill development workshops. CONCLUSIONS:These clinicians were able to acquire the skills to implement SDM competences and to use risk communication aids. Each intervention provided independent effects. Further progress towards greater patient involvement in health care decision making is possible, and skill development in this area should be incorporated into postgraduate professional development programmes.
journal_name
Fam Practjournal_title
Family practiceauthors
Elwyn G,Edwards A,Hood K,Robling M,Atwell C,Russell I,Wensing M,Grol R,Study Steering Group.doi
10.1093/fampra/cmh401subject
Has Abstractpub_date
2004-08-01 00:00:00pages
337-46issue
4eissn
0263-2136issn
1460-2229pii
21/4/337journal_volume
21pub_type
临床试验,杂志文章,随机对照试验相关文献
FAMILY PRACTICE文献大全abstract:Aim:Multimorbidity is a growing phenomenon in primary care, and knowledge of the influence of social determinants on its evolution is vital. The aim of this study was to understand the relationship between multimorbidity and immigration, taking into account length of residence in the host country and area of origin of ...
journal_title:Family practice
pub_type: 杂志文章
doi:10.1093/fampra/cmx048
更新日期:2017-11-16 00:00:00
abstract:BACKGROUND:Both treatment guidelines and the amount of antibiotics used for acute otitis media (AOM) vary across western countries. Parental expectations and their awareness of antimicrobial use and resistance, which may also be influenced by the guidelines, are not yet completely known. OBJECTIVE:To compare parental ...
journal_title:Family practice
pub_type: 杂志文章
doi:10.1093/fampra/cmp055
更新日期:2009-12-01 00:00:00
abstract:BACKGROUND:While health systems are striving for patient-centered care, they have little evidence to guide them on how to engage patients in their care, or how this may affect patient experiences and outcomes. OBJECTIVE:To explore which specific patient-centered aspects of care were best associated with depression imp...
journal_title:Family practice
pub_type: 杂志文章
doi:10.1093/fampra/cmw068
更新日期:2016-12-01 00:00:00
abstract::The present study was performed to investigate the predictive value of casual blood pressure recordings for mortality in a geographically defined population (n = 1917), for which the primary health care services are responsible. Isotonic regression of blood pressure on age was used to define groups with low, medium an...
journal_title:Family practice
pub_type: 杂志文章
doi:10.1093/fampra/3.1.3
更新日期:1986-03-01 00:00:00
abstract:BACKGROUND:The World Health Organization and the World Organization of Family Doctors have called for 'doable' and 'limited' tasks to integrate mental health into primary care. Little information is provided about tasks GPs can undertake outside of guidelines that suggest to prescribe medication and refer to specialist...
journal_title:Family practice
pub_type: 杂志文章
doi:10.1093/fampra/cmq016
更新日期:2010-08-01 00:00:00
abstract::This paper examines the notions of adverse events, error, critical incidents and safety from the specific viewpoint of primary care. We conclude that each term can be defined, but existing work which we reviewed uses many of the terms interchangeably. We recognise that trying to access medical error objectively within...
journal_title:Family practice
pub_type: 杂志文章,评审
doi:10.1093/fampra/cmg302
更新日期:2003-06-01 00:00:00
abstract:Background:Late-life depression often coincides with chronic somatic diseases and, consequently, with polypharmacy, which may complicate medical treatment. Objective:To determine the associations between patients diagnosed with late-life depression in primary care and multimorbidity and polypharmacy. Methods:This cro...
journal_title:Family practice
pub_type: 杂志文章
doi:10.1093/fampra/cmx018
更新日期:2017-09-01 00:00:00
abstract::The aim of this study was to investigate how much inter- and intrareviewer agreement there was with regard to the classification of research designs and the assessment of the methodological quality of research reports. This was done by means of formal criteria and criteria relating to content. Three successive reliabi...
journal_title:Family practice
pub_type: 杂志文章
doi:10.1093/fampra/12.1.93
更新日期:1995-03-01 00:00:00
abstract::What happens in first encounters between patients and physiotherapists? Videotaped encounters between two patients and their physiotherapists were analysed in depth to try to answer this question. It is advocated that attention must not be restricted to either clinical decision making or communication, but needs to be...
journal_title:Family practice
pub_type: 杂志文章
doi:10.1093/fampra/9.2.195
更新日期:1992-06-01 00:00:00
abstract::To determine whether patients read and remembered health promotion messages displayed in waiting rooms, 600 patients in a UK general practice were given a self-complete questionnaire. Two notice-boards carried between 1 to 4 topics over four study periods. Three-hundred and twenty-seven (55%) of subjects responded. Tw...
journal_title:Family practice
pub_type: 杂志文章
doi:10.1093/fampra/11.3.292
更新日期:1994-09-01 00:00:00
abstract:BACKGROUND:Few studies have evaluated roles of general practice-based pharmacists (PBPs), particularly in optimizing medicines management for older people with both multimorbidity and polypharmacy. OBJECTIVE:To explore the types and effectiveness of services provided by PBPs, either alone or in collaboration with othe...
journal_title:Family practice
pub_type: 杂志文章
doi:10.1093/fampra/cmaa146
更新日期:2021-01-28 00:00:00
abstract:BACKGROUND:recruitment targets to randomized controlled trials (RCTs) are often not met. Many interventions are used to improve recruitment but there is little empirical evidence on whether these approaches work. OBJECTIVE:to examine whether changes to the design and conduct of a primary care-based RCT were associated...
journal_title:Family practice
pub_type: 杂志文章
doi:10.1093/fampra/cmq050
更新日期:2010-12-01 00:00:00
abstract:INTRODUCTION:In the last decade of the 20th century, the countries of Central and Eastern Europe (CEE) have experienced rapid changes in health policies. This process was largely supported by international grants. After this support has ended, it is important to keep up with the development, developing its own strategi...
journal_title:Family practice
pub_type: 杂志文章
doi:10.1093/fampra/cmn009
更新日期:2008-04-01 00:00:00
abstract:BACKGROUND:In view of the pending mental health (MH) reform, an increase in demand of MH services is expected. Primary care physicians will presumably be involved in meeting this expected increased demand. OBJECTIVES:To identify the preferable route of service use of populations with MH problems based on data from the...
journal_title:Family practice
pub_type: 杂志文章
doi:10.1093/fampra/cms017
更新日期:2012-10-01 00:00:00
abstract::The functional status of patients was determined during an acute attack of asthma requiring medical intervention. Patients were recruited during two months from general practice: all 28 patients consulting for an acute asthma attack were invited to take part: four refused or were withdrawn from follow up. Matched cont...
journal_title:Family practice
pub_type: 杂志文章
doi:10.1093/fampra/8.4.404
更新日期:1991-12-01 00:00:00
abstract:BACKGROUND:Little is known about the frequency with which information from the Internet is presented by patients within primary care consultations or the subsequent impact that it may have on those consultations. OBJECTIVES:The aims of this study were to describe the frequency with which Internet information was prese...
journal_title:Family practice
pub_type: 杂志文章
doi:10.1093/fampra/cmh215
更新日期:2004-04-01 00:00:00
abstract:BACKGROUND:Qualitative research methods are recognized increasingly as valuable tools for primary care research, and add an extra dimension to quantitative work. OBJECTIVE:The aim of this study was to illustrate the benefits and problems attending the dual role of clinician/qualitative researcher. METHODS:As part of ...
journal_title:Family practice
pub_type: 杂志文章
doi:10.1093/fampra/19.3.285
更新日期:2002-06-01 00:00:00
abstract:BACKGROUND:About 45.2 million people were displaced from their homes in 2012 due to persecution, political conflict, generalized violence and human rights violations. Refugees who endure violence are at increased risk of developing chronic psychiatric disorders such as posttraumatic stress disorder and major depression...
journal_title:Family practice
pub_type: 杂志文章
doi:10.1093/fampra/cmu017
更新日期:2014-08-01 00:00:00
abstract:BACKGROUND:Antibiotics are over-prescribed for lower respiratory tract infection (LRTI). The influence of clinicians' history and examination findings on antibiotic prescribing for LRTI has not been directly assessed, and the extent to which these clinical findings predict appropriate antibiotic prescribing is unknown....
journal_title:Family practice
pub_type: 杂志文章
doi:10.1093/fampra/cmi100
更新日期:2006-04-01 00:00:00
abstract:BACKGROUND:In recent years, we have investigated both patients' and family doctors' communicative characteristics towards nutrition communication in general practice with several qualitative and quantitative studies. A sound comparison of the survey results between both conversation partners has not been made before. ...
journal_title:Family practice
pub_type: 杂志文章
doi:10.1093/fampra/cmn061
更新日期:2008-12-01 00:00:00
abstract:OBJECTIVES:The aim of the present study was to describe, using a national census, the characteristics of rural general practices and compare these with city and town general practices. METHODS:A previously piloted, anonymous but linked, questionnaire was issued to all GPs in Ireland. A liaison network covering the cou...
journal_title:Family practice
pub_type: 杂志文章
doi:10.1093/fampra/18.6.622
更新日期:2001-12-01 00:00:00
abstract:BACKGROUND:Current pandemic influenza plans to place GPs at the front line of a pandemic influenza response. However, little is known about GPs' perceptions of their role and preparedness in the event of a pandemic occurring. OBJECTIVE:Our aim was to assess general practice preparedness to respond to pandemic influenz...
journal_title:Family practice
pub_type: 杂志文章
doi:10.1093/fampra/cml014
更新日期:2006-06-01 00:00:00
abstract:BACKGROUND:The incidence of cancer as well as survival rates for it are increasing. It is debated whether care in the chronic phase of cancer can be positioned in primary care due to doubts about capacity and workload. OBJECTIVE:To estimate GPs' extra consultation time if they assume responsibility for the care in the...
journal_title:Family practice
pub_type: 杂志文章
doi:10.1093/fampra/cmv098
更新日期:2016-02-01 00:00:00
abstract:OBJECTIVES:The aim of the study was to validate a new case-finding instrument for common mental disorders (CMDQ). METHODS:A cross-sectional, stratified, two-phase study was carried out in 28 general practices in Aarhus County, Denmark. 1785 consecutive patients, 18-65 years old, consulting 38 GPs with a new health pro...
journal_title:Family practice
pub_type: 杂志文章
doi:10.1093/fampra/cmi025
更新日期:2005-08-01 00:00:00
abstract:BACKGROUND:Nearly three-quarters of patients seen in specialist outpatient clinics in England are in follow-up. It has been suggested that the care of many of these patients could be transferred to general practice. OBJECTIVES:We aimed to estimate the proportion of patients in general practice who are in long-term out...
journal_title:Family practice
pub_type: 杂志文章
doi:10.1093/fampra/14.1.24
更新日期:1997-02-01 00:00:00
abstract:BACKGROUND:Patient experience and satisfaction are important indicators of quality in health care. Little is known about where to prioritize efforts to improve patient satisfaction. OBJECTIVES:To investigate patient satisfaction with primary care, as part of the Quality and Costs of Primary Care in Europe study in Eng...
journal_title:Family practice
pub_type: 杂志文章
doi:10.1093/fampra/cmw004
更新日期:2016-04-01 00:00:00
abstract:BACKGROUND:Individual signs and symptoms are of limited value for the diagnosis of influenza. OBJECTIVE:To develop a decision tree for the diagnosis of influenza based on a classification and regression tree (CART) analysis. METHODS:Data from two previous similar cohort studies were assembled into a single dataset. T...
journal_title:Family practice
pub_type: 杂志文章
doi:10.1093/fampra/cms020
更新日期:2012-12-01 00:00:00
abstract:OBJECTIVE:To assess the results achieved with a rapid referral pathway for suspected colorectal cancer (CRC), comparing with the standard referral pathway. METHODS:Three-year audit of patients suspected of having CRC routed via a rapid referral pathway, and patients with CRC routed via the standard referral pathway of...
journal_title:Family practice
pub_type: 杂志文章
doi:10.1093/fampra/cmr080
更新日期:2012-04-01 00:00:00
abstract::Before implementing a guideline, reassurance is needed that the guideline is valid, reproducible and reliable. A method for assessing guideline validity has now been developed for general use. Guideline producers need to consider suitable strategies for implementing their guidelines. When designing and evaluating a gu...
journal_title:Family practice
pub_type: 杂志文章
doi:10.1093/fampra/17.suppl_1.s3
更新日期:2000-02-01 00:00:00
abstract:BACKGROUND:Client or consumer expectation is considered to influence their satisfaction with the service provided, but its importance has not been quantified in health care. OBJECTIVE:The aim of this study was to determine the effect of "patient expectations of care" on satisfaction with care provided by out-of-hours ...
journal_title:Family practice
pub_type: 杂志文章
doi:10.1093/fampra/19.4.333
更新日期:2002-08-01 00:00:00