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US-based cross-sectional survey of clinicians’ knowledge and attitudes about shared decision-making across healthcare professions and specialties
  1. Rachel C Forcino1,
  2. Renata West Yen1,
  3. Maya Aboumrad1,2,
  4. Paul J Barr1,
  5. Danielle Schubbe1,
  6. Glyn Elwyn1,
  7. Marie-Anne Durand1
  1. 1 The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
  2. 2 White River Junction VA Medical Center, White River Junction, Vermont, USA
  1. Correspondence to Dr Marie-Anne Durand; marie-anne.durand{at}


Objective In this study, we aim to compare shared decision-making (SDM) knowledge and attitudes between US-based physician assistants (PAs), nurse practitioners (NPs) and physicians across surgical and family medicine specialties.

Setting We administered a cross-sectional, web-based survey between 20 September 2017 and 1 November 2017.

Participants 272 US-based NPs, PA and physicians completed the survey. 250 physicians were sent a generic email invitation to participate, of whom 100 completed the survey. 3300 NPs and PAs were invited, among whom 172 completed the survey. Individuals who met the following exclusion criteria were excluded from participation: (1) lack of English proficiency; (2) area of practice other than family medicine or surgery; (3) licensure other than physician, PA or NP; (4) practicing in a country other than the US.

Results We found few substantial differences in SDM knowledge and attitudes across clinician types, revealing positive attitudes across the sample paired with low to moderate knowledge. Family medicine professionals (PAs) were most knowledgeable on several items. Very few respondents (3%; 95% CI 1.5% to 6.2%) favoured a paternalistic approach to decision-making.

Conclusions Recent policy-level promotion of SDM may have influenced positive clinician attitudes towards SDM. Positive attitudes despite limited knowledge warrant SDM training across occupations and specialties, while encouraging all clinicians to promote SDM. Given positive attitudes and similar knowledge across clinician types, we recommend that SDM is not confined to the patient-physician dyad but instead advocated among other health professionals.

  • organisation of health services
  • quality In health care

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  • Contributors RCF contributed to the design of the work, analysis and interpretation of data and drafting the work. RWY, MA, PJB and GE contributed to the design and revision of the work. DS contributed to data analysis and revision of the work. M-AD contributed to the conception and design of the work, interpretation of data and revision of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests M-AD was involved in developing the Option Grid patient decision aids, which are licensed to EBSCO Health. She receives consulting income from EBSCO Health and may receive royalties in the future. M-AD is also a consultant for ACCESS Community Health Network and delivers shared decision making training to ACCESS clinicians. GE has edited and published books that provide royalties on sales by the publishers: the books include Shared Decision Making (Oxford University Press) and Groups (Radcliffe Press). He has in the past provided consultancy for (1) Emmi Solutions LLC who develop patient decision support tools; (2) National Quality Forum on the certification of decision support tools; (3) Washington State Health Department on the certification of decision support tools; (4) SciMentum LLC, Amsterdam (workshops for shared decision making). GE is Director of &think LLC which owns the registered trademark for Option GridsTM patient decision aids. He provides consultancy in the domain of shared decision making and patient decision aids to: (1) Access Community Health Network, Chicago (Federally Qualified Medical Centers) and to (2) EBSCO Health Option GridsTM patient decision aids. GE initiated the Option Grid Collaborative, tools that are hosted on a website managed by Dartmouth College, on Existing Option Grids hosted at this website are freely available until such time as the tools have expired. He owns copyright in measures of shared decision making and care integration, namely CollaboRATE, IntegRATE and Observer OPTION. These measures are freely available for use.

  • Patient consent Not required.

  • Ethics approval Dartmouth College’s Committee for the Protection of Human Subjects (study #30303).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement A deidentified participant-level dataset is available on request to the corresponding author (Marie-Anne Durand).

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