Do consultants do what they say they do? Observational study of the extent to which clinicians involve their patients in the decision-making process

Abstract

Objectives

To assess whether consultants do what they say they do in reaching decisions with their patients.

Design

Cross-sectional analysis of hospital outpatient encounters, comparing consultants’ self-reported usual decision-making style to their actual observed decision-making behaviour in video-recorded encounters.

Setting

Large secondary care teaching hospital in the Netherlands.

Participants

41 consultants from 18 disciplines and 781 patients.

Primary and secondary outcome measure

With the Control Preference Scale, the self-reported usual decision-making style was assessed (paternalistic, informative or shared decision making). Two independent raters assessed decision-making behaviour for each decision using the Observing Patient Involvement (OPTION) ⁵ instrument ranging from 0 (no shared decision making (SDM)) to 100 (optimal SDM).

Results

Consultants reported their usual decision-making style as informative (n=11), shared (n=16) and paternalistic (n=14). Overall, patient involvement was low, with mean (SD) OPTION ⁵ scores of 16.8 (17.1). In an unadjusted multilevel analysis, the reported usual decision-making style was not related to the OPTION ⁵ score (p>0.156). After adjusting for patient, consultant and consultation characteristics, higher OPTION ⁵ scores were only significantly related to the category of decisions (treatment vs the other categories) and to longer consultation duration (p<0.001).

Conclusions

The limited patient involvement that we observed was not associated with the consultants’ self-reported usual decision-making style. Consultants appear to be unconsciously incompetent in shared decision making. This can hinder the transfer of this crucial communication skill to students and junior doctors.