What are the ingredients for a successful evidence-based patient choice consultation?: A qualitative study.
The evidence-based patient choice (EBPC) approach is one of a number of newly emerging templates for medical encounters that advocate evidence-informed choice and shared decision-making. These models emphasise respect for patient preferences for involvement in health care decisions and advocate the sharing of good quality evidence-based information. In the medical consultation EBPC involves providing patients with evidence-based information in a way that facilitates their ability to make choices or decisions about their health care. Whereas the key principles of shared decision-making have been conceptualised, so far, no qualitative investigations have been undertaken to establish the key components of an EBPC consultation. Therefore, a series of semi-structured interviews were carried out with key informants to identify the elements and skills required for a successful EBPC consultation to occur. The interviews were conducted with purposively selected UK general practitioners (n=11), hospital doctors (n=10), practice nurses (n=5), academics (n=11) and lay people (n=8). Qualitative analysis of participants' responses was conducted using the constant comparative method. Six main themes emerged from the data, these were research evidence/medical information, the doctor-patient relationship, patient perspectives, decision-making processes, time issues and establishing the patient's problem. All respondents placed importance on doctors and patients being well informed and appraised of the latest available medical evidence. There was a general view that evidence-based information regarding diagnosis and treatment options should be shared with patients during a consultation. However, there were no suggestions as to how this might be achieved in practice. Participants' opinions relating to which model of decision-making should be adopted ranged from favouring an informed choice model, to the view that decision-making should be shared equally. Similarly, there was no clear view on how much guidance a doctor should offer a patient during decision-making concerning the most appropriate treatment option for that patient.
Ford
Sarah
S
The Ethox Centre, Institute of Health Sciences, University of Oxford, Old Road, Headington, OX3 7LF, Oxford, UK. sarah.ford@ethox.ox.ac.uk
Schofield
Theo
T
Hope
Tony
T
D001291:Attitude of Health Personnel; D003657:Decision Making; D019317:Evidence-Based Medicine; D006801:Humans; D007407:Interviews as Topic; D010358:Patient Participation; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000592:standards*; D011361:Professional Competence; D036301:Qualitative Research; D012017:Referral and Consultation / Q000592:standards; D006113:United Kingdom