TY - JOUR
KW - *Decision making
KW - *General practice
KW - *Older adults
KW - *Primary care
KW - *Shared decision making
AU - Jansen J.
AU - Patel Bindu
AU - Muscat D.
AU - Shepherd H.
AU - Hay L.
AU - Shivarev A.
AU - McKinn S.
AU - Bonner C.
AU - McCaffery K.
AB - OBJECTIVES: To explore how decisions are made in real-life general practice consultations with older patients (65+ years), and examine how general practitioners (GPs) communicate risk and benefit information and evidence, and integrate patient preferences. METHODS: Secondary analysis of 20 video-recorded consultations with older patients in Australian primary healthcare settings. Consultations were analysed qualitatively using the Framework method and quantitatively using the Observer OPTION(5) scale and the Assessing Communication about Evidence and Patient Preferences (ACEPP) tool. RESULTS: Overall, Observer OPTION(5) and ACEPP scores were low, with mean total scores of 11.3 (out of 100) and 10.4 (out of 40) respectively. Together with qualitative findings, these results suggest that shared decision-making did not occur, and that healthcare options (including anticipated benefits and risks), evidence and patient preferences were rarely discussed in our sample of consultations with older people. GPs often unilaterally made treatment decisions (usually pharmacotherapy) while patients reverted to a passive decision-making role. CONCLUSION: We observed a lack of shared decision-making in our primary care study, with little engagement of older patients in decisions about their health. PRACTICE IMPLICATIONS: Training and support tools may be needed to enhance the capacity and self-efficacy of providers and older patients to share healthcare decisions.
AD - University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab, Sydney, Australia.<br/>University of Sydney, Faculty of Science, School of Psychology, Sydney, Australia; University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney, Australia.<br/>University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney, Australia.<br/>University of Sydney, Faculty of Medicine and Health, School of Public Health, Australia; The George Institute for Global Health, University of New South Wales, Australia.<br/>University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab, Sydney, Australia; University of Sydney, Faculty of Medicine and Health, School of Public Health, Wiser Healthcare, Sydney, Australia.<br/>University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab, Sydney, Australia; University of Sydney, Faculty of Medicine and Health, School of Public Health, Wiser Healthcare, Sydney, Australia. Electronic address: jesse.jansen@sydney.edu.au.
AN - 30578105
BT - Patient Educ CounsPatient Educ CounsPatient Educ Couns
DA - 38842693078
DP - NLM
ET - 2018/12/24
J2 - Patient education and counseling
LA - eng
M1 - 5
N1 - 1873-5134<br/>Muscat, Danielle Marie<br/>Shepherd, Heather L<br/>Hay, Louise<br/>Shivarev, Alex<br/>Patel, Bindu<br/>McKinn, Shannon<br/>Bonner, Carissa<br/>McCaffery, Kirsten<br/>Jansen, Jesse<br/>Journal Article<br/>Research Support, Non-U.S. Gov't<br/>Ireland<br/>Patient Educ Couns. 2019 May;102(5):879-887. doi: 10.1016/j.pec.2018.12.001. Epub 2018 Dec 3.
N2 - OBJECTIVES: To explore how decisions are made in real-life general practice consultations with older patients (65+ years), and examine how general practitioners (GPs) communicate risk and benefit information and evidence, and integrate patient preferences. METHODS: Secondary analysis of 20 video-recorded consultations with older patients in Australian primary healthcare settings. Consultations were analysed qualitatively using the Framework method and quantitatively using the Observer OPTION(5) scale and the Assessing Communication about Evidence and Patient Preferences (ACEPP) tool. RESULTS: Overall, Observer OPTION(5) and ACEPP scores were low, with mean total scores of 11.3 (out of 100) and 10.4 (out of 40) respectively. Together with qualitative findings, these results suggest that shared decision-making did not occur, and that healthcare options (including anticipated benefits and risks), evidence and patient preferences were rarely discussed in our sample of consultations with older people. GPs often unilaterally made treatment decisions (usually pharmacotherapy) while patients reverted to a passive decision-making role. CONCLUSION: We observed a lack of shared decision-making in our primary care study, with little engagement of older patients in decisions about their health. PRACTICE IMPLICATIONS: Training and support tools may be needed to enhance the capacity and self-efficacy of providers and older patients to share healthcare decisions.
PY - 2019
SN - 0738-3991
SP - 879
EP - 887
ST - Patient education and counselingPatient education and counseling
T2 - Patient Educ CounsPatient Educ CounsPatient Educ Couns
TI - Discussions about evidence and preferences in real-life general practice consultations with older patients
VL - 102
ER -