Shared treatment decision making: what does it mean to physicians?
OBJECTIVE
Physicians are urged to practice shared treatment decision making (STDM), yet this concept is poorly understood. We developed a conceptual framework describing essential characteristics of a shared approach. This study assessed the degree of congruence in the meanings of STDM as described in the framework and as perceived by practicing physicians.


METHODS
A cross-sectional survey questionnaire was mailed to eligible Ontario medical and radiation oncologists and surgeons treating women with early-stage breast cancer. Open-ended and structured questions elicited physicians' perceptions of shared decision making.


RESULTS
Most study physicians spontaneously described STDM using characteristics identified in the framework as essential to this concept. When presented with clinical examples in which the decision-making roles of physicians and patients were systematically varied, study physicians overwhelmingly identified example 4 as illustrating a shared approach. This example was deliberately constructed to depict STDM as defined in the framework. In addition, more than 85.0% of physicians identified as important to STDM specific patient and physician roles derived from the framework. These included the following: the physician gives information to the patient on treatment benefits and risks; the patient gives information to the physician about her values; the patient and physician discuss treatment options; both agree on the treatment to implement.


CONCLUSIONS
Substantial congruence was found between the meaning of STDM as described in the framework and as perceived by study physicians. This supports use of the framework as a conceptual tool to guide research, compare different treatment decision-making approaches, clarify the meaning of STDM, and enhance its translation into practice.
Charles
Cathy A
CA
Department of Clinical Epidemiology, McMaster University, Hamilton, Ontario, Canada. charlesc@mcmaster.ca
Whelan
Tim
T
Gafni
Amiram
A
Willan
Andy
A
Farrell
Sylvia
S
D001291:Attitude of Health Personnel; D001943:Breast Neoplasms / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D006302:Health Services Research; D006801:Humans; D009864:Ontario; D010358:Patient Participation; D017060:Patient Satisfaction; D026684:Personal Autonomy; D010817:Physician-Patient Relations; D011795:Surveys and Questionnaires