The physiatrist’s attitude towards Shared Decision-Making a further analysis among physiatrists on the role of shared decision-making in rehabilitation healthcare

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3.3Current extend of providing information

Table 2 displays the mean scores for several topics of the extent to which physiatrists reported giving information. Overall, physiatrist reported a great degree of information providing, with a mean average score of 3.48 on a five-point scale ranging from 1 (no information sharing) to 5 (a great deal of information sharing). Especially on the extent of the disease and the effects of treatment on patients’ ability to care for themselves, a great deal of information was reported to be given to patients. Topics on which information was provided to a lesser extend, were changes in appearance due to the treatment and the impact of the treatment on sexuality.

Table 2. Extend of information giving to patients on different aspects

Information content

Mean (SD)

Extent of the disease

4.03 (0.79)

Details on treatment procedures

3.93 (0.73)

Benefits of treatment

3.98 (0.65)

Risk (side effects) of treatment

3.49 (0.93)

Impact of treatment on sexuality

2.28 (1.08)

Changes in appearance due to treatment

2.11 (1.12)

Effects of treatment on mood

3.31 (1.17)

Effects of treatment on family

3.50 (1.12)

Effects of treatment on social activities

3.98 (0.79)

Effects of treatment on patients’ ability to care for themselves

4.07 (0.92)

Average score

3.48 (0.53)

Note. The scores are on a Likert scale ranging from 1 (no information) to 5 (a great degree of information).

3.4Current way of decision-making

The vast majority of respondents indicated that their usual approach resembles the shared decision-making example. Only a small fraction of physiatrists indicated to usually adopt a paternalistic approach. Table 3 provides physiatrists’ self-reported use of the four approaches to treatment decision-making.

On the question how comfortable physiatrists feel with each of the four approaches, the highest levels of comfort were reported for the shared decision-making model. Overall, physiatrists showed a strong preference for approaches with patient participation in decision-making, as can be seen from Table 4.

This table also shows the percentage of physiatrists recording a high level of comfort with each of the four decision-making examples. Eighty percent, the vast majority, of the respondents reported a high level of comfort with the shared decision-making approach. The lowest levels of comfort were reported for the paternalistic model, though still 28.3% reported high levels of comfort with the approach.

There was a considerable gap of 33.5% in the proportion of physiatrists who said they usually practiced shared decision-making (47.3%) and the proportion reporting high levels of comfort with this approach (80.8%). For the other approaches, comfort levels with the approach exceeded self-reported use too, though this gap was a lot smaller for the paternalistic approach (25.1%).

Table 3. Percentage of physiatrists reporting to use one of the approaches in the examples as their usual approach to treatment decision-making. (N=102)

Decision making model

n (%)

Paternalistic approach

3 (3.2)

Approach with some sharing

25 (26.9)

Shared decision-making

44 (47.3)

Informed decision-making

16 (17.2)

None of these / other

5 (5.4)

Note. Physiatrists were asked which of four examples resembled their usual approach to treatment decision-making the best. Each example represented one of the four models in the table, though no labels were attached to the examples. Percentages are based on valid cases only.

Table 4. Physiatrists’ level of comfort with four decision-making approaches (N=102)

Decision making model

Mean (SD)

n (%)a

Paternalistic approach

2.67 (1.25)

28 (28.3)

Approach with some sharing

3.61 (1.08)

65 (65.0)

Shared decision-making

4.17 (0.86)

80 (80.8)

Informed decision-making

3.24 (1.22)

47 (48.0)

Note. Percentages are based on valid cases only. a Percentage of physiatrists reporting a “high level of comfort”, which is operationalized as a score of 4 or 5 on a Likert scale ranging from 1 (very uncomfortable) to 5 (extremely comfortable).

The majority of the physiatrists (48.5%) indicated they initiate a discussion on the extent to which the patient wanted to participate in the decision-making process with one of their patients on a regular basis. Twenty-six percent indicated that regularly one of their patients initiates a discussion about the degree of participation in the decision-making process.

When asked if the physiatrist gives their patients the choice for treatment when several options are available, the majority (57.8%) of the respondents cited to do this often. Most physiatrists (52.9%) said they often recommended a treatment, when several options are available.

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