Supporting patients facing difficult health care decisions: use of the Ottawa Decision Support Framework.

Full Abstract

OBJECTIVE:
To investigate family physicians' views on factors that make health care decisions difficult for patients, interventions family physicians use to support patients making decisions, and interventions proposed by the Ottawa Decision Support Framework (ODSF).

DESIGN:
Thirteen group discussions.

SETTING:
Five family practice units.

PARTICIPANTS:
One hundred twenty family physicians.

INTERVENTIONS:
The multifaceted implementation intervention consisted of feedback from participants, a reminder at point of care, and an interactive workshop. During the workshop, family physicians were asked about their views on 2 videos both showing the concluding phase of a simulated clinical encounter with a woman facing a decision about hormone therapy. One video showed usual care; the other showed use of the ODSF process and related tools. Content was analyzed using observations by non-participants, field notes, material collected from participants during workshops, evaluation forms completed at the end of workshops, and comments written on exit questionnaires from the implementation trial.

MAIN OUTCOME MEASURES:
Family physicians' views on the types of difficult decisions their patients face, the factors that make decisions difficult for patients, the interventions family physicians use to support patients' decisions, and the interventions proposed by the ODSF.

RESULTS:
The 2 most frequently cited factors making decisions difficult for patients were experiencing uncertainty and fears about adverse outcomes. Before being introduced to the ODSF, participants had used mostly information-related strategies to provide decision support. After learning about the ODSF, participants overwhelmingly identified assessing patients' values as a priority. At the end of the workshop, the 5 changes in practice participants most frequently intended to make were, in order of importance, to assess patients' values, to ask about patients' preferred role in decision making, to screen for decisional conflict, to assess support or undue pressure on patients, and to increase patients' involvement in decision making.

CONCLUSION:
The ODSF process and related tools have the potential to broaden family physicians' views on supporting patients facing difficult decisions.

Learn Faster Today Improve your study skills

Author information

Author/s: Légaré, France (F); O'Connor, Annette C (AC); Graham, Ian (I); Saucier, Danielle (D); Côté, Luc (L); Cauchon, Michel (M); Paré, Line (L);

Affiliation: Department of Family Medicine, Laval University, Quebec city, Quebec, Canada. France.legare(-atsign-)mfa.ulaval.ca

Journal and publication information

Publication Type: Journal Article; Research Support, Non-U.S. Gov't

Journal: Canadian family physician Médecin de famille canadien (Can Fam Physician), published in Canada. (Language: eng)

Reference: 2006-Apr; vol 52 (issue ) : pp 476-7

Dates: Created 2007/02/28; Completed 2007/04/10; Revised 2008/11/20;

PMID: 17327891, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

External Links for this article (including full text providers, if available):

Click Electronic Full-text Provider Links to see options for finding the electronic full text links to this article. Note there may be a subscription or fee required for access to the full text. See our FAQ for information on finding FREE full text articles.

This article may also be located in paper journal collections available in many libraries. Use the Journal and Publication Information above to find the full article.

MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Attitude of Health Personnel
Canada
Decision Support Techniques
Emotions
Family Practice - methods; statistics & numerical data
Female
Health Care Surveys
Humans

Humans
Male
Patient Education as Topic - methods
Patient Participation - methods
Physician's Role
Physician-Patient Relations
Professional Practice - statistics & numerical data
Qualitative Research

These are the highest related articles currently in the database:

See 100+ related articles.