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      The impact of a physician’s recommendation and gender on informed decision making: A randomized controlled study in a simulated decision situation

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          Abstract

          Objective

          This study examined the influence of physicians’ recommendations and gender on the decision‐making process in a preference‐sensitive situation.

          Methods

          N = 201 participants were put in a hypothetical scenario in which they suffered from a rupture of the anterior cruciate ligament (ACL). They received general information on two equally successful treatment options for this injury (surgery vs physiotherapy) and answered questions regarding their treatment preference, certainty and satisfaction regarding their decision and attitude towards the treatment options. Then, participants watched a video that differed regarding physician's recommendation (surgery vs physiotherapy) and physician's gender (female vs male voice and picture). Afterwards, they indicated again their treatment preference, certainty, satisfaction and attitude, as well as the physician's professional and social competence.

          Results

          Participants changed their treatment preferences in the direction of the physician's recommendation ( P < .001). Decision certainty ( P < .001) and satisfaction ( P < .001) increased more strongly if the physician's recommendation was congruent with the participant's prior attitude than if the recommendation was contrary to the participant's prior attitude. Finally, participants’ attitudes towards the recommended treatment became more positive (surgery recommendation: P < .001; physiotherapy recommendation: P < .001). We found no influence of the physician's gender on participants’ decisions, attitudes, or competence assessments.

          Conclusion

          This research indicates that physicians should be careful with recommendations when aiming for shared decisions, as they might influence patients even if the patients have been made aware that they should take their personal preferences into account. This could be particularly problematic if the recommendation is not in line with the patient's preferences.

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          Most cited references53

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          Decision aids for people facing health treatment or screening decisions.

          Decision aids are interventions that support patients by making their decisions explicit, providing information about options and associated benefits/harms, and helping clarify congruence between decisions and personal values.
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            Shared decision making--pinnacle of patient-centered care.

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              Where is the evidence? A systematic review of shared decision making and patient outcomes.

              Despite widespread advocacy for shared decision making (SDM), the empirical evidence regarding its effectiveness to improve patient outcomes has not been systematically reviewed. The purpose of this study was to systematically review the empirical evidence linking patient outcomes and SDM, when the decision-making process has been explicitly measured, and to identify under what measurement perspectives SDM is associated with which types of patient outcomes (affective-cognitive, behavioral, and health). PubMed (through December 2012) and hand search of article bibliographies. Studies were included if they empirically 1) measured SDM in the context of a patient-clinician interaction and 2) evaluated the relationship between SDM and at least 1 patient outcome. Study results were categorized by SDM measurement perspective (patient-reported, clinician-reported, or observer-rated) and outcome type (affective-cognitive, behavioral, or health). Thirty-nine studies met inclusion criteria. Thirty-three used patient-reported measures of SDM, 6 used observer-rated measures, and 2 used clinician-reported measures. Ninety-seven unique patient outcomes were assessed; 51% affective-cognitive, 28% behavioral, and 21% health. Only 43% of assessments (n = 42) found a significant and positive relationship between SDM and the patient outcome. This proportion varied by SDM measurement perspective and outcome category. It was found that 52% of outcomes assessed with patient-reported SDM were significant and positive, compared with 21% with observer-rated and 0% with clinician-reported SDM. Regardless of measurement perspective, SDM was most likely to be associated with affective-cognitive patient outcomes (54%), compared with 37% of behavioral and 25% of health outcomes. The relatively small number of studies precludes meta-analysis. Because the study inclusion and exclusion criteria required both an empirical measure of SDM and an assessment of the association between that measure and a patient outcome, most included studies were observational in design. SDM, when perceived by patients as occurring, tends to result in improved affective-cognitive outcomes. Evidence is lacking for the association between empirical measures of SDM and patient behavioral and health outcomes. © The Author(s) 2014.
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                Author and article information

                Contributors
                Role: Research Assistant
                Role: Research Associatem.eggeling@iwm-tuebingen.de
                Role: Professor
                Role: Professor
                Role: Research Associate
                Journal
                Health Expect
                Health Expect
                10.1111/(ISSN)1369-7625
                HEX
                Health Expectations : An International Journal of Public Participation in Health Care and Health Policy
                John Wiley and Sons Inc. (Hoboken )
                1369-6513
                1369-7625
                04 December 2020
                April 2021
                : 24
                : 2 ( doiID: 10.1111/hex.v24.2 )
                : 269-281
                Affiliations
                [ 1 ] Knowledge Construction Lab Leibniz‐Institut fuer Wissensmedien Tuebingen Germany
                [ 2 ] Department of Psychology University of Tuebingen Tuebingen Germany
                Author notes
                [*] [* ] Correspondence

                Marie Eggeling, Leibniz‐Institut fuer Wissensmedien, Schleichstr. 6, D‐72076 Tuebingen, Germany.

                Email: m.eggeling@ 123456iwm-tuebingen.de

                Author information
                https://orcid.org/0000-0001-9749-7321
                https://orcid.org/0000-0002-8996-8303
                https://orcid.org/0000-0002-6345-9498
                https://orcid.org/0000-0002-1312-4032
                Article
                HEX13161
                10.1111/hex.13161
                8077152
                33274816
                3be4ef66-8ce5-45f4-91c4-a315acb28851
                © 2020 The Authors. Health Expectations published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 17 September 2020
                : 13 June 2020
                : 29 October 2020
                Page count
                Figures: 3, Tables: 4, Pages: 13, Words: 9440
                Funding
                Funded by: Leibniz Science Campus Tuebingen
                Categories
                Original Research Paper
                Original Research Papers
                Custom metadata
                2.0
                April 2021
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.2 mode:remove_FC converted:27.04.2021

                Health & Social care
                attitude,decision satisfaction,gender,medical decision making,physiotherapy,recommendations,surgery

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