Abstract
OBJECTIVE: To examine experiences of older persons and their clinicians with shared decision making (SDM) and their willingness to use an SDM instrument.
DESIGN: Qualitative focus group study.
PARTICIPANTS: Four focus groups of 41 older persons and 2 focus groups of 11 clinicians, purposively sampled to encompass a range of sociodemographic and clinical characteristics.
APPROACH AND MAIN RESULTS: Audiotaped responses were transcribed, coded independently, and analyzed by 3 reviewers using the constant comparative method. Patient participants described using informal facilitators of shared decision making and supported use of an SDM instrument to keep “the doctor and patient on the same page.” They envisioned the instrument as “part of the medical record” that could be “referenced at home.” Clinician participants described the instrument as a “motivational and educational tool” that could “customize care for individual patients.” Some clinician and patient participants expressed reluctance given time constraints and unfamiliarity with the process of setting participatory clinical goals.
CONCLUSIONS: Participants indicated that they would use a shared decision-making instrument in their clinical encounters and attributed multiple functions to the instrument, especially as a tool to facilitate agreement with treatment goals and plans.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Von Korff M, Gruman J, Schaefer J, Curry SJ, Wagner EH. Collaborative management of chronic illness. Ann Intern Med. 1997;127:1097–102.
Bogardus ST, Bradley EH, Williams CS, Maciejewski PK, van Doorn C, Inouye SK. Goals for the care of frail older adults: do caregivers and clinicians agree? Am J Med. 2001;110:97–102.
Strull WM, Lo B, Charles G. Do patients want to participate in medical decision making? JAMA. 1984;252:2990–4.
Rockwood K, Stadnyk K, Carver D, et al. A clinimetric evaluation of specialized geriatric care for rural dwelling, frail older people. J Am Geriatr Soc. 2000;48:1080–5.
Quill TE. Partnerships in patient care: a contractual approach. Ann Intern Med. 1983;98:228–34.
Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: translating evidence into action. Health Aff. 2001;20:64–78.
Charles C, Gafni A, Whelan T. Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model. Soc Sci Med. 1999;49:651–61.
Coulter A. Partnerships with patients: the pros and cons of shared clinical decision-making. J Health Serv Res Policy. 1997;2:112–21.
Bogardus ST Jr, Bradley EH, Williams CS, Maciejewski PK, Gallo WT, Inouye SK. Achieving goals in geriatric assessment: role of caregiver agreement and adherence to recommendations. J Am Geriatr Soc. 2004;52:99–105.
Guadagnoli E, Ward P. Patient participation in decision-making. Soc Sci Med. 1998;47:329–39.
Glasgow RE, Anderson RM. In diabetes care, moving from compliance to adherence is not enough. Something entirely different is needed. Diabetes Care. 1999;22:2090–2.
Bradley EH, Bogardus ST Jr, Tinetti ME, Inouye SK. Goal-setting in clinical medicine. Soc Sci Med. 1999;49:267–78.
Deber RB, Kraetschmer N, Irvine J. What role do patients wish to play in treatment decision making? Arch Intern Med. 1996;156:1414–20.
Beisecker AE, Beisecker TD. Patient information-seeking behaviors when communicating with doctors. Med Care. 1990;28:19–28.
Austin J, Vancouver J. Goal constructs in psychology: structure, process, and content. Psychol Bull. 1996;120:338–75.
Locke EA, Latham GP. The Theory of Goal-setting and Task Performance. Englewood Cliffs, NJ: Prentice Hall; 1990.
Krueger RA, Casey MA. Focus Groups: A Practical Guide for Applied Research. 3rd ed. Thousand Oaks, CA: SAGE; 2000.
Strauss A, Corbin J. Basics of Qualitative Research. 2nd ed. Thousand Oaks, CA: Sage; 1998.
Huberman M, Miles MB. Qualitative Data Analysis: An Expanded Sourcebook. 2nd ed. Thousand Oaks, CA: Sage Publications; 1994.
Von Korff M, Glasgow RE, Sharpe M. Organising care for chronic illness. BMJ. 2002;325:92–94.
Author information
Authors and Affiliations
Corresponding author
Additional information
The authors have no conflicts of interest to report.
This research was supported by a center grant from a joint program of the Hartford and RAND foundations: Building Interdisciplinary Geriatric Health Care Research.
Rights and permissions
About this article
Cite this article
Naik, A.D., Schulman-Green, D., McCorkle, R. et al. Will older persons and their clinicians use a shared decision-making instrument?. J GEN INTERN MED 20, 640–643 (2005). https://doi.org/10.1007/s11606-005-0110-8
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s11606-005-0110-8