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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3.6Current use decision aids


The vast majority of physiatrists (91.0%) indicated to use a leaflet or brochure. Handwritten notes also came forward as an often used aid (69.0%). Websites were used by 18%. Decision boards (7%), videos (7%), CD-ROMs (3%) were reported to be used by only a small portion of the respondents.

On the question how often they used one of the decision-aids, the majority of the respondents answered they used it regularly (57%) or often (18%). Eight percent said to never use a decision aid, three percent to use it always.


3.7 Attitude towards decision aids


On the attitude scale for the use of decision aids, most physiatrists showed a moderately positive attitude (mean average score=3.13, SD=0.49). The mean score for each item is shown in Table 7. As the table shows, the strongest agreements were with the assertion that decision aids will cause patients to be more involved in decision-making and the assertion that the majority of patients does not wish to be involved in decision-making.

Table 7. Mean scores on physiatrists’ attitude towards the use decision aids (N=102)



Item (1 = strongly agree; 5 = Strongly disagree)


Mean (SD)

Patients should see a decision aid before they make a treatment decision

2.98 (0.97)

Patients using a decision aid will be better informed

3.62 (0.87)

All eligible patients should be referred to a decision aid

3.55 (1.03)

A decision aid may cause some patients to make the wrong choice a

2.90 (1.03)

A decision aid will cause patients to be more involved in decision-making about treatment

3.64 (0.96)

A decision aid will cause patients to ask more questions than they would otherwise have asked

3.63 (0.81)

Knowing risks and benefits, most patients want to decide how acceptable treatment is to them

3.49 (0.89)

Patients usually want to be an equal partner with physicians in making important treatment decisions

2.72 (0.81)

Majority of patients does not wish to be involved in decision-making about their treatment a

3.77 (0.99)

Most patients prefer the doctor to take responsibility for their medical problems a

2.63 (0.95)

With a decision aid I will be able to reduce time spent educating patients about treatment

2.74 (1.09)

Using a decision aid will reduce the risk of malpractice

2.62 (1.04)

A decision aid will eliminate the need for third party utilization such as second opinion

2.39 (1.03)

Average score

3.13 (0.49)

Note. Means and standard deviations based on valid cases only. a before calculating the mean average scores, item scores on these negatively formulated items were reversed.

3.8Influence of physiatrists’ characteristics and work settings on physiatrist attitude towards shared decision-making


As Table 9 shows, there were significant correlations found between gender and the attitude towards the informed decision-making model. Men showed a higher level of comfort with this approach (M= 3.49, SD=1.19) than women (M=2.96, SD=1.21). No significant correlations were found between gender and levels of comfort with one of the three other approaches.

A significant correlation was found between the level of comfort reported for the informed decision-making approach and the average amount of patients a physiatrist sees in a week. Physiatrists who reported to see more patients in a week, were more likely to report higher levels of comfort with the informed decision-making model.

Physiatrists working primarily with CVA patients or patients with traumatic brain injury reported higher levels of comfort with the paternalistic approach (M=3.00, SD=1.16) than physiatrists working primarily with other groups (M=2.26, SD=1.20). They also reported a higher comfort level with the some sharing approach (M=3.92, SD=0.86) than the physiatrists working with patient groups without cognitive limitation (M=3.26, SD=1.22). Even a significant correlation was found between the diagnose group and the attitude towards the informed approach, with physiatrists working with cognitive limited patients reporting a higher level of comfort with this approach (M=3.56, SD=1.19) than the other physiatrists (M=2.98, SD=1.19). The mean score on the physiatrists attitude towards shared decision-making was lower among physiatrist working with cognitive limited patients (M=4.08, SD=0.91) than among other physiatrists (M=4.30, SD=0.773), though this relationship did not reach significance (p= .342).

To see if the physiatrists working with a cognitive limited patient group also reported to use the approaches for which they reported higher levels of comfort as their common approach to decision-making more often than the group of physiatrists as whole, response frequencies were compared. These comparisons showed that physiatrists working with cognitive limited patients reported to use the paternalistic approach as their common approach more often than the sample as a whole (8.3% versus 3.2%). The informed approach was the most popular (41.7%), the informed approach the least (8.3%). Twenty-nine percent reported the shared decision-making approach to be their usual model for decision-making.

The Pearson correlation coefficients for the relationship between physiatrists’ characteristics and their attitude towards use of decision aid showed no significant correlations. No significant correlations were found between physiatrist’s characteristics and the measure for information provision.

Table 9. Correlations between characteristics of the physiatrists and work setting and their attitude towards several decision-making models and the use of decision aids. (N=102)



Attitude towards

Paternalistic


Some sharing

Shared decision-making

Informed decision-making

Use of decision aids

Gender

.100

-.102

.079

.219*


-.004

Age

.064

-.025

-.082

.162

-.077

Years in practice

.098

.062

.005

.161

-.058

Clinical setting

.001

-.043

.019

.095

-.064

Amount of patients per week

.062

-.081

.110

.347**

-.003

Duration of average consult

-.053

-.049

-.084

-.106

.043

Cognitive limited patients

.289*


.270*


-.117

.242*

-.148


* p<0.05, two-tailed. **p<0.01, two-tailed


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