Abstract
Purpose of the Study and Background
With a strong political agenda for change towards patient-centred healthcare, the notion of shared decision-making is reported to substantially improve patient experience, adherence to treatment and health outcomes. In clinical practice however, observational studies have shown shared decision-making is rarely implemented and patient preferences are seldom met.
The aim of this study was to measure the extent of shared decision-making in clinical encounters involving physiotherapists and patients with low back pain.
Methods and Results
Eighty outpatient encounters (from 12 clinicians) were observed, audio-recorded, transcribed verbatim and analysed using the OPTION instrument. This measures 12 decision-making items, rated on a scale 0–4, which are summated and scaled to give a percentage: The higher the score, the greater the shared decision-making competency.
The mean OPTION score was 24.0% (range 10.4%–43.8%). Providing patients with a list of treatment options was the only behaviour exhibited by every clinician, however in 73.8%, this was not demonstrated beyond a perfunctory level. Failure to offer the choice of doing nothing, or deferring the decision precluded clinicians from attaining a higher OPTION score.
Conclusion
Despite the political agenda, a paternalistic view of care was evident and shared decision-making was under-developed in this cohort of patients with back pain. Providing a comprehensive outline of the available treatment options forms part of the duty-of-care and, whilst clinicians may have altruistic motives and a strong desire to treat, depending on patient preference and clinical indicators, doing nothing could be a legitimate option.
