Patient involvement in clinical decision making: the effect of GP attitude on patient satisfaction

Abstract

Objective This study investigates general practitionersÕ (GPs) and patientsÕ attitudes to shared decision making, and how these attitudes affect patient satisfaction.Background Sharing of information and decisions in the consultation is largely accepted as the ideal in general practice. Studies show that most patients prefer to be involved in decision making and shared decision making is associated with patient satisfaction, although preferences vary. Still we know little about how the interaction of GP and patientsÕ attitudes affects patient satisfaction. One such study was conducted in the USA, but comparative studies are lacking.Design Questionnaire survey distributed through GPs. Setting and participantsThe results are based on the combined questionnaires of 41 GPs and 829 of their patients in the urban municipality of Bergen in the western part of Norway.Main variables studied The data were collected using a nine-item survey instrument constructed to measure attitudes towards patient involvement in medical consultations. The patients were also asked to rate their satisfaction with their GP.Results and conclusions The patients had a strong preference for shared decision making. The GPs also generally preferred shared decision making, but to a lesser degree than the patients, which is the opposite of the findings of the US study. There was a positive effect of the GP's attitude towards shared decision making on patient satisfaction, but no significant effect of congruence of attitudes between patient and GP on patient satisfaction. The suggested explanation is that GPs that are positive to sharing decisions are more responsive to patientsÕ needs and therefore satisfy patients even when the patient's attitude differs from the GPsÕ attitude. Hence, although some patients do prefer a passive role, it is important to promote positive attitudes towards patient involvement in medical consultations.

Preferences for participation in shared decision making of psychiatric outpatients with affective disorders

“…Finally, although previous studies have demonstrated that high level education is a determinant of preference for shared decision making [28,29], our results nevertheless showed that the higher the patients' educational level is the more they preferred to leave final decisions to their psychiatrist. Paraphrasing David Byrne "The more you know, the more you know you don't know and the more you know that you don't know".…”

GPs' implicit prioritization through clinical choices – evidence from three national health services

“…The initial identification of relevant attributes was based predominantly on findings from an earlier survey of Norwegian doctors' adherence to guidelines (Carlsen & Aakvik, 2006;Carlsen & Norheim, 2008), existing international research on both prioritization and guidelines (Carlsen & Norheim, 2005;Eccles & Grimshaw, 2004;Farquhar et al, 2002;Stewart et al, 2003;Strech et al, 2008), as well as theoretical expertise and practical experience (with DCEs in general and with conducting DCEs in different local contexts) in the international research team. The choice models applied in the analysis rely on the assumption that respondents are able to make trade-offs between attributes and their levels in order to maximise utility.…”

Where have all the copy letters gone? A review of current practice in professional–patient correspondence

“…Communication between patients and professionals is increasingly recognised as a complex process with interpersonal relationships and communicative behaviours during consultations influencing information exchange [59] and shared decision-making [60]. The take up of the option to become more involved such as by receiving copy letters may therefore be significantly influenced by the interaction between patient and professional, and the way that copy correspondence is offered.…”

“…Copying correspondence has also been highlighted as a factor in perceptions of improved or shared decision-making during a consultation [19,20], and with increased patient satisfaction [21,22]. It has been suggested that copying correspondence can be seen as part of a changing culture in healthcare delivery [23], with patient empowerment requiring the sharing of knowledge [24,25], allowing an individual more control over their own healthcare [18,26].…”