PT  - JOURNAL ARTICLE
AU  - Ellen M Driever
AU  - Anne M Stiggelbout
AU  - Paul L P Brand
TI  - Do consultants do what they say they do? Observational study of the extent to which clinicians involve their patients in the decision-making process
AID  - 10.1136/bmjopen-2021-056471
DP  - 2022 Jan 01
TA  - BMJ Open
PG  - e056471
VI  - 12
IP  - 1
4099  - http://bmjopen.bmj.com/content/12/1/e056471.short
4100  - http://bmjopen.bmj.com/content/12/1/e056471.full
SO  - BMJ Open2022 Jan 01; 12
AB  - Objectives To assess whether consultants do what they say they do in reaching decisions with their patients.Design Cross-sectional analysis of hospital outpatient encounters, comparing consultants’ self-reported usual decision-making style to their actual observed decision-making behaviour in video-recorded encounters.Setting Large secondary care teaching hospital in the Netherlands.Participants 41 consultants from 18 disciplines and 781 patients.Primary and secondary outcome measure With the Control Preference Scale, the self-reported usual decision-making style was assessed (paternalistic, informative or shared decision making). Two independent raters assessed decision-making behaviour for each decision using the Observing Patient Involvement (OPTION)5 instrument ranging from 0 (no shared decision making (SDM)) to 100 (optimal SDM).Results Consultants reported their usual decision-making style as informative (n=11), shared (n=16) and paternalistic (n=14). Overall, patient involvement was low, with mean (SD) OPTION5 scores of 16.8 (17.1). In an unadjusted multilevel analysis, the reported usual decision-making style was not related to the OPTION5 score (p>0.156). After adjusting for patient, consultant and consultation characteristics, higher OPTION5 scores were only significantly related to the category of decisions (treatment vs the other categories) and to longer consultation duration (p<0.001).Conclusions The limited patient involvement that we observed was not associated with the consultants’ self-reported usual decision-making style. Consultants appear to be unconsciously incompetent in shared decision making. This can hinder the transfer of this crucial communication skill to students and junior doctors.Data are available on reasonable request. The data used and/or analysed during the current study are available from the corresponding author on reasonable request.