Agreement between physicians and patients about what constitutes shared decision making
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6065 Background: Involving patients in making decisions about their own care is increasingly desirable for patients with serious illness. Shared decision making is one such model, the attributes of which have been well defined (Charles et al., Soc Sci Med,1997,1999). However, it is unclear whether physicians and patients agree on what constitutes a SDM interaction. Methods: Semi-structured interviews were undertaken with 21 medical and radiation oncologists and 14 cancer patients attending a regional cancer centre. Participants were asked what they thought it meant for the patient and physician to share in DM. Responses were compared to the theoretical constructs of SDM defined by Charles et al: information exchange (flow, direction, type, amount), deliberation, and who makes the decision. Two analysts independently reviewed the interviews for patient and physician definitions of SDM and compared these with the Charles et al. model of SDM using explicit classification decision rules. There were few discrepancies between analysts and agreement was reached in all cases. Results: 71% of physicians and 29% of patients described a two-way flow and direction of information exchange as necessary for SDM. Only 24% of physicians and 21% of patients described the exchange of both medical and personal information. All participants indicated that more than the minimum legally required amount of information was needed. 67% of physicians and 36% of patients described both patient and physician involvement in deliberation about treatment as a component of SDM. 48% of physicians and 21% of patients identified both patients and physicians are involved in deciding what treatment to implement in a shared approach. Overall, none of the participant definitions identified all the components of the SDM model. Physicians in their definitions, identified more components than did patients. Conclusions: Physicians appear to have a stronger understanding of the elements involved in SDM. These differences may lead to different expectations about patient involvement in DM. Physicians have a responsibility for ensuring that patients are invited to contribute to all components of SDM in the oncology consultation. No significant financial relationships to disclose.
