Framing the Clinical Encounter: Shared Decision-Making, Mammography Screening, and Decision Satisfaction

Abstract

The study examines whether physicians' framing of clinical interactions is related to patient shared decision-making (SDM) satisfaction when using a clinical decision support tool (CDST) concerning mammographic screening. To answer this question, we combined (a) system log data from a CDST, (b) content coding of the physicians' message framing while using the CDST, and (c) a post-visit patient survey to assess SDM satisfaction concerning screening mammography. Results suggest that two types of message frames -consequence frames and numerical framesmoderated the relationship of the CDST on SDM satisfaction. When the CDST displayed low risk of breast cancer for a patient, physicians were able to improve the cognitive aspects of SDM satisfaction by framing the consequences of mammography screening in positive terms. However, when the physician delivered the numerical information in relative, rather than absolute terms, the patient's SDM satisfaction was reduced. Our study advances previous message framing effect research in health communication from experimental settings to clinical encounters. It also discusses the importance of delivering risk-congruent frames in clinical settings.

Team Science Principles Enhance Cancer Care Delivery Quality Improvement: Interdisciplinary Implementation of Breast Cancer Screening Shared Decision Making

“…28,30,31 We also found that primary care provider framing of risk and potential outcomes during the SDM interaction influenced patient satisfaction. 31…”

“…Provider-identified barriers included not enough time for discussion although having the SDM available in the EHR helped. 28,30,31 We also found that primary care provider framing of risk and potential outcomes during the SDM interaction influenced patient satisfaction. 31 Team consensus (Table 1) revealed that TS principles varied by the PDSA cycle and phase.…”

“…Eleven providers were invited to test B∼CARE 1.0 ( Do ). After these providers engaged in conversations with 51 women considering mammography using B∼CARE 1.0, we surveyed these patients and providers to assess feasibility, satisfaction, and potential outcomes 29-31 ( Study ). On the basis of patient 30,32 and provider 30 input, we made modifications to B∼CARE 1.0 ( Act ) in advance of implementation (Fig 1).…”

“…Eleven providers were invited to test B~CARE 1.0 (Do). After these providers engaged in conversations with 51 women considering mammography using B~CARE 1.0, we surveyed these patients and providers to assess feasibility, satisfaction, and potential outcomes [29][30][31] (Study). On the basis of patient 30,32 and provider 30 PDSA cycle 2 (January 1, 2016-December 31, 2018): Our team codified core components of breast cancer screening SDM via a Delphi 33 -see the Data Supplement for details of patient/provider contributions, the development of a Toolkit, 34 and alignment with UW Health clinical SDM guidelines in preparation for widespread clinical use of B~CARE 2.0 (Plan).…”

Patient-provider communication while using a clinical decision support tool: explaining satisfaction with shared decision making for mammography screening

“…The formula defined by O'Connor calls for items to be summed, divided by 15, and multiplied by 25, such that total scores range from 0 to 100. For ease of interpretation, decisional conflict scores were reverse coded such that higher scores indicate higher satisfaction with SDM, whereas lower scores represent lower satisfaction with SDM [43].…”