Impact of DECISION + 2 on patient and physician assessment of shared decision making implementation in the context of antibiotics use for acute respiratory infections

Implementation Science

Michel Labrecque³  Stéphane Turcotte²  Caroline Rhéaume¹  Catherine Nadeau²  Mireille Guerrier²  France Légaré³ 

[1] Research Center of Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, QC, Canada;Research Center of the Centre Hospitalier Universitaire de Québec, Hôpital St-François d’Assise, 10, Rue Espinay, Quebec City, QC G1L 3 L5, Canada;Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada

关键词: Training;    Theory of planned behavior;    Implementation;    Shared decision making;   

Others  :  810659
DOI  :  10.1186/1748-5908-8-144

 received in 2013-06-07, accepted in 2013-12-23,  发布年份 2013

【 摘 要 】

Background

DECISION + 2, a training program for physicians, is designed to implement shared decision making (SDM) in the context of antibiotics use for acute respiratory tract infections (ARTIs). We evaluated the impact of DECISION + 2 on SDM implementation as assessed by patients and physicians, and on physicians’ intention to engage in SDM.

Methods

From 2010 to 2011, a multi-center, two-arm, parallel randomized clustered trial appraised the effects of DECISION + 2 on the decision to use antibiotics for patients consulting for ARTIs. We randomized 12 family practice teaching units (FPTUs) to either DECISION + 2 or usual care. After the consultation, both physicians and patients independently completed questionnaires based on the D-Option scale regarding SDM behaviors during the consultation. Patients also answered items assessing the role they assumed during the consultation (active/collaborative/passive). Before and after the intervention, physicians completed a questionnaire based on the Theory of Planned Behavior to measure their intention to engage in SDM. To account for the cluster design, we used generalized estimating equations and generalized linear mixed models to assess the impact of DECISION + 2 on the outcomes of interest.

Results

A total of 270 physicians (66% women) participated in the study. After DECISION + 2, patients’ D-Option scores were 80.1 ± 1.1 out of 100 in the intervention group and 74.9 ± 1.1 in the control group (p = 0.001). Physicians’ D-Option scores were 79.7 ± 1.8 in the intervention group and 76.3 ± 1.9 in the control group (p = 0.2). However, subgroup analyses showed that teacher physicians D-Option scores were 79.7 ± 1.5 and 73.0 ± 1.4 respectively (p = 0.001). More patients reported assuming an active or collaborative role in the intervention group (67.1%), than in the control group (49.2%) (p = 0.04). There was a significant relation between patients’ and physicians’ D-Option scores (p < 0.01) and also between patient-reported assumed roles and both D-Option scores (as assessed by patients, p < 0.01; and physicians, p = 0.01). DECISION + 2 had no impact on the intention of physicians to engage in SDM.

Conclusion

DECISION + 2 positively influenced SDM behaviors as assessed by patients and teacher physicians. Physicians’ intention to engage in SDM was not affected by DECISION + 2.

Trial registration

ClinicalTrials.gov trials register no. NCT01116076.

【 授权许可】

   
2013 Légaré et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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