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Abstract
Objectives To describe the range of collaborative approaches to shared decision-making (SDM) observed in clinical encounters of patients with diabetes and their clinicians.
Design A secondary analysis of videorecordings obtained in a randomised trial comparing usual diabetes primary care with or without using a within-encounter conversation SDM tool.
Setting Using the purposeful SDM framework, we classified the forms of SDM observed in a random sample of 100 video-recorded clinical encounters of patients with type 2 diabetes in primary care.
Main outcome measures We assessed the correlation between the extent to which each form of SDM was used and patient involvement (OPTION12-scale).
Results We observed at least one instance of SDM in 86 of 100 encounters. In 31 (36%) of these 86 encounters, we found only one form of SDM, in 25 (29%) two forms, and in 30 (35%), we found ≥3 forms of SDM. In these encounters, 196 instances of SDM were identified, with weighing alternatives (n=64 of 196, 33%), negotiating conflicting desires (n=59, 30%) and problemsolving (n=70, 36%) being similarly prevalent and developing existential insight accounting for only 1% (n=3) of instances. Only the form of SDM focused on weighing alternatives was correlated with a higher OPTION12-score. More forms of SDM were used when medications were changed (2.4 SDM forms (SD 1.48) vs 1.8 (SD 1.46); p=0.050).
Conclusions After considering forms of SDM beyond weighing alternatives, SDM was present in most encounters. Clinicians and patients often used different forms of SDM within the same encounter. Recognising a range of SDM forms that clinicians and patients use to respond to problematic situations, as demonstrated in this study, opens new lines of research, education and practice that may advance patient-centred, evidence-based care.
- Diabetes Mellitus
Data availability statement
Data are available upon reasonable request. Deidentified data from the video recordings used in this study are available upon reasonable request at the ‘Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester’.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Data availability statement
Data are available upon reasonable request. Deidentified data from the video recordings used in this study are available upon reasonable request at the ‘Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester’.
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Footnotes
Twitter @vmontori, @MarleenKunneman
Contributors MMR, VM and MK conceived and designed this study. MMR and MK coded all video-recorded clinical encounters in duplicate. MEB performed all data analyses. MMR, VM, IH, MEB, MLG, EJPdK and MK helped to interpret the study results, drafted and revised the manuscript and approved the final version. MMR and MK are the guarantors of this work and, as such, had full access to all the data in the study and take responsibility for the integrity and accuracy of the data and data analyses.
Funding This work was supported by a personal Veni-grant from the Dutch Research Council (NWO) and The Netherlands Organisation for Health Research and Development (ZonMw) of M.K., grant number [#016.196.138] and a personal doctoral award from Health Institute Carlos III of M.L.G., grant number [#MV20/00050].
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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