Shared decision making in consultations for hypertension: Qualitative study in general practice

Abstract

Background Hypertension is mainly managed in primary care. Shared decision making is widely recommended as an approach to treatment decision making. However, no studies have investigated; in detail, what happens during primary care consultations for hypertension. Aim To understand patients’ and clinicians’ experience of shared decision making for hypertension in primary care, in order to propose how it might be better supported. Design Longitudinal qualitative study. Setting Five general practices in south‐west England. Method Interviews with a purposive sample of patients with hypertension, and with the health‐care practitioners they consulted, along with observations of clinical consultations, for up to 6 appointments. Interviews and consultations were audio‐recorded and observational field notes taken. Data were analysed thematically. Results Forty‐six interviews and 18 consultations were observed, with 11 patients and nine health‐care practitioners (five GPs, one pharmacist and three nurses). Little shared decision making was described by participants or observed. Often patients’ understanding of their hypertension was limited, and they were not aware there were treatment choices. Consultations provided few opportunities for patients and clinicians to reach a shared understanding of their treatment choices. Opportunities for patients to engage in choices were limited by structured consultations and the distribution of decisions across consultations. Conclusion For shared decision making to be better supported, consultations need to provide opportunities for patients to learn about their condition, to understand that there are treatment choices, and to discuss these choices with clinicians. Patient or Public Contribution A patient group contributed to the design of this study.

Improving Hypertension Control in the Black Patient Population

“…The redesign of care delivery in this project served to accomplish 3 key standardized changes in workflow: identification of uncontrolled BP prior to the visit, assurance that patients received a knowledge assessment and picture-based, audible video series to address knowledge gaps, and facilitation of tailored goal-setting and shared decision-making around BP goals. These findings support those of Olomu et al19 and others,20-22 suggesting that designing clinic workflow around priority patient goals and sharing common information on improvement can effectively improve key outcomes, even among Black patients in high-risk demographic areas. In addition, improving patients' awareness and knowledge of uncontrolled BP implications and clinician access to BP improvements over time can help align treatment choices with patients' preferences and values, improving health equity by actively engaging patients in health care decision-making with clinicians 19-22…”

“…These findings support those of Olomu et al19 and others,20-22 suggesting that designing clinic workflow around priority patient goals and sharing common information on improvement can effectively improve key outcomes, even among Black patients in high-risk demographic areas. In addition, improving patients' awareness and knowledge of uncontrolled BP implications and clinician access to BP improvements over time can help align treatment choices with patients' preferences and values, improving health equity by actively engaging patients in health care decision-making with clinicians 19-22…”

“…In addition, improving patients' awareness and knowledge of uncontrolled BP implications and clinician access to BP improvements over time can help align treatment choices with patients' preferences and values, improving health equity by actively engaging patients in health care decision-making with clinicians. [19][20][21][22] Unlike most prior publications to date, this project used an integrated EHR patient portal to support the multifactorial intervention, including screening for uncontrolled BP, documentation of telephone outreach prior to visits, charge-capture for BP cuff distribution, and coordination of the activities of a team-based approach including screening for SDOH and mental health needs. Although the significance and implications of psychosocial factors in cardiovascular disease are well documented, 23 the redesign of clinic workflow to accommodate screening for social, health-related needs and to integrate patient support for these needs in an integrated visit is new.…”

Barriers and Facilitators of Medication Adherence in Hypertension Patients: A Meta-Integration of Qualitative Research

“… 67 According to a qualitative study, consultations should give patients the chance to learn about their disease, comprehend that they have treatment options, and discuss these options with physicians in order to better enable shared decision-making. 68 In addition, doctors can use the reference results given by artificial intelligence to assist in recommending medication. For example, Duan et al 69 developed an X-learner machine learning model that can be automatically built into an electronic medical record that predicts whether hypertensive patients are more likely to benefit or risk medication based on demographic and clinical characteristics.…”

Efficacy of a Decision Support Intervention on Decisional Conflict Related to Hepatocellular Cancer Treatment: A Randomized Controlled Trial

“…Due to time constraints and emotional disturbance, patients often make difficult choices without carefully considering the options and consequences (Faiman & Tariman, 2019). Patients may be reluctant to ask clinicians questions for fear of being perceived as difficult and therefore receiving poorer care (Johnson et al, 2021; Roe et al, 2021). In addition, many patients lack awareness of their options and do not express their expectations.…”