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      How often do both core competencies of shared decision making occur in family medicine teaching clinics? Translated title: À quelle fréquence rencontre-t-on les deux principales compétences de la prise de décisions en commun dans les cliniques d’enseignement universitaire de médecine familiale?

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          Abstract

          Objective

          To assess how often risk communication and values clarification occur in routine family medicine practice and to explore factors associated with their occurrence.

          Design

          Qualitative and quantitative cross-sectional study.

          Setting

          Five university-affiliated family medicine teaching clinics across Quebec.

          Participants

          Seventy-one health professionals (55% physicians, 35% residents, 10% nurses or dietitians) and 238 patients (76% women; age range 16 to 82 years old).

          Main outcome measures

          The presence or absence of risk communication and values clarification during visits in which decisions were made was determined. Factors associated with the primary outcome (both competencies together) were identified. The OPTION5 (observing patient involvement in decision making) instrument was used to validate the dichotomous outcome.

          Results

          The presence of risk communication and values clarification during visits was associated with OPTION5 scores (area under the curve of 0.80, 95% CI 0.75 to 0.86, P < .001). Both core competencies of shared decision making occurred in 150 of 238 (63%) visits (95% CI 54% to 70%). Such an occurrence was more likely when the visit included discussion about beginning something new, treatment options, or postponing a decision, as well as when health professionals preferred a collaborative decision-making style and when the visit included more decisions or was longer. Alone, risk communication occurred in 203 of 238 (85%) visits (95% CI 82% to 96%) and values clarification in 162 of 238 (68%) visits (95% CI 61% to 75%).

          Conclusion

          Health professionals in family medicine are making an effort to engage patients in shared decision making in routine daily practice, especially when there is time to do so. The greatest potential for improvement might lie in values clarification; that is, discussing what matters to patients and families.

          Résumé

          Objectif

          Déterminer à quelle fréquence la communication des risques et la clarification des valeurs sont présentes ensemble dans les cliniques de santé familiales habituelles et examiner les facteurs associés à cette fréquence.

          Type d’étude

          Une étude transversale qualitative et quantitative.

          Contexte

          Cinq unités d’enseignement universitaire de santé familiale du Québec.

          Participants

          Un total de 71 professionnels de la santé (55 % médecins, 35 % résidents, 10 % infirmières ou diététiciens) et 238 patients (76 % femmes; âgés de 16 à 82 ans).

          Principaux paramètres à l’étude

          On a déterminé la présence ou l’absence de la communication des risques et de la clarification des valeurs au cours des consultations où des décisions étaient prises. On a identifié les facteurs qui influaient sur la présence des 2 compétences. L’instrument OPTION5 ( observing patient involvement in decision making) a servi à valider un résultat dichotomique.

          Résultats

          On a observé une association entre la présence de la communication des risques et de la clarification des valeurs, et les scores obtenus à OPTION5 (surface sous la courbe de 0.80, IC à 95 % 0.75 à 0.86, P < .001). Les deux compétences pour la prise de décision partagée étaient présentes dans 150 consultations sur 238 (63 %, IC à 95 % 54 % à 70 %). Cette situation était plus susceptible de survenir lorsque la visite incluait des discussions sur la possibilité d’entreprendre quelque chose de nouveau, les traitements possibles ou le report d’une décision, mais aussi lorsque les professionnels de la santé préféraient un type de prise de décision collaborative et quand la consultation était plus longue ou portait sur plusieurs décisions. Dans 203 cas sur 238, on avait utilisé seulement la communication des risques, (85 %, IC à 95 % 82 % à 96 %) et dans 162 cas sur 238, seulement la clarification des valeurs (68 %, IC à 95 % 61 % à 75 %).

          Conclusion

          Dans la pratique quotidienne, les professionnels de la santé en médecine familiale s’efforcent d’amener les patients à prendre des décisions en commun, particulièrement lorsqu’il est temps de le faire. Discuter avec les patients des choses qui leur importent est ce qui présente le plus fort potentiel d’amélioration.

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          Author and article information

          Journal
          Can Fam Physician
          Can Fam Physician
          cfp
          CFP
          Canadian Family Physician
          College of Family Physicians of Canada
          0008-350X
          1715-5258
          February 2019
          : 65
          : 2
          : e64-e75
          Affiliations
          Clinical research coordinator at the Jewish General Hospital in Montreal, Que.
          Research associate in the Research Unit of the Office of Education and Professional Development at Laval University in Quebec city, Que.
          Doctoral student in psychology at Laval University.
          Biostatistician in the Clinical Research Platform of the Research Centre of the CHU de Québec in Quebec city.
          Practising family physician and Full Professor in the Department of Family and Emergency Medicine at Laval University, Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Scientific Co-director of the Canadian Cochrane Network Site at Laval University, and a researcher at the Centre de recherche sur les soins et les services de première ligne de l’Université Laval (CERSSPL-UL).
          Professor in the Department of Family and Emergency Medicine and a researcher in the Office of Education and Professional Development in the Faculty of Medicine at Laval University.
          Medical student in the Faculty of Medicine at Laval University.
          Resident in the Faculty of Medicine at Laval University.
          Consultant with the Pan American Health Organization and the World Health Organization in Washington, DC.
          Oncologist in the Division of Radiation Oncology in the Department of Medicine at the CHU de Québec–Laval University.
          Family physician in the Herzl Family Practice Centre in Montreal, and Associate Professor in the Department of Family Medicine and Director of the Clinician Scholar Program in the Department of Family Medicine at McGill University in Montreal.
          Associate Professor in the Department of Family and Emergency Medicine and a researcher in the Office of Education and Professional Development at Laval University, the Centre d’excellence sur le vieillissement de Québec at the Research Centre of the CHU de Québec, and the CERSSPL-UL.
          Associate Professor in the Department of Family and Emergency Medicine and a researcher in the Office of Education and Professional Development at Laval University, Population Health and Optimal Health Practices at the Research Centre of the CHU de Québec, the Ottawa Hospital Research Institute in Ontario, and the CERSSPL-UL.
          Author notes
          Correspondence: Dr Holly O. Witteman; e-mail holly.witteman@ 123456fmed.ulaval.ca
          Article
          PMC6515489 PMC6515489 6515489 e64
          6515489
          30765371
          eb33ed75-9798-4acf-949c-5d20a401211a
          Copyright© the College of Family Physicians of Canada
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