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Impact of the Ottawa Decision Support Framework on the Agreement and the Difference between Patients' and Physicians' Decisional Conflict

Department of Family Medicine, Laval University, Hôpital St. François d'Assise, 10, rue de l'Espinay, Québec G1L 3L5, Canada france.legare{at}mfa.ulaval.ca

Annette M. O'Connor, RN, PhD

Ian D. Graham, PhD

Georges A. Wells, PhD

University of Ottawa, Ottawa, Ontario, Canada

Stéphane Tremblay, MSc

Background. The Ottawa Decision Support Framework (ODSF) provides a process that facilitates shared decision making. Objective. To assess the impact of implementing the ODSF on the agreement and the difference between patients' and physicians' decisional conflict scores. Design. In total, 120 physicians and 903 patients enrolled in this before-and-after study. Implementation of the ODSF was composed of an interactive workshop, feedback, and a reminder at the point of care. The Decisional Conflict Scale (DCS) was completed by physicians and patients after a clinical encounter. Results. The intraclass correlation coefficient was–0.205 ± 0.096 (95% confidence interval [CI]= – 0.224 to –0.186) before implementing the ODSF and– 0.013 ± 0.114 (95% CI = – 0.036 to 0.009) after. At the patient level, the following factors were significantly associated with the difference between the patients' and physicians' DCS: unemployed (P = 0.023), implementing the ODSF (P = 0.008), high school degree (P = 0.04), male (P = 0.03), and unilateral role in decision making (P = 0.03). At the physician level, provincial committee (P = 0.001), national committee (P = 0.045), clinical site (P = 0.016), reluctance to share uncertainty (P = 0.023), and anxiety due to uncertainty (P = 0.017) were significantly associated with this outcome. Conclusion. After implementing the ODSF, there was less dissimilarity between patients' and physicians' DSC than expected by chance than before. Implementing the ODSF was also found to be associated with the difference between patients' and physicians' DSC. The physician level explained a significant amount of the variance in this outcome, thus emphasizing the importance of an intervention at this level.

Key Words: shared decision making • decisional conflict • patient-physician interaction • uncertainty • multilevel analysis

Medical Decision Making, Vol. 26, No. 4, 373-390 (2006)
DOI: 10.1177/0272989X06290492


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