Impact of the Ottawa Decision Support Framework on the agreement and the difference between patients' and physicians' decisional conflict.
BACKGROUND
The Ottawa Decision Support Framework (ODSF) provides a process that facilitates shared decision making.


OBJECTIVE
To assess the impact of implementing the ODSF on the agreement and the difference between patients' and physicians' decisional conflict scores.


METHODS
In total, 120 physicians and 903 patients enrolled in this before-and-after study. Implementation of the ODSF was composed of an interactive workshop, feedback, and a reminder at the point of care. The Decisional Conflict Scale (DCS) was completed by physicians and patients after a clinical encounter.


RESULTS
The intraclass correlation coefficient was-0.205 +/- 0.096 (95% confidence interval [CI]= - 0.224 to -0.186) before implementing the ODSF and- 0.013 +/- 0.114 (95% CI = - 0.036 to 0.009) after. At the patient level, the following factors were significantly associated with the difference between the patients' and physicians' DCS: unemployed (P = 0.023), implementing the ODSF (P = 0.008), high school degree (P = 0.04), male (P = 0.03), and unilateral role in decision making (P = 0.03). At the physician level, provincial committee (P = 0.001), national committee (P = 0.045), clinical site (P = 0.016), reluctance to share uncertainty (P = 0.023), and anxiety due to uncertainty (P = 0.017) were significantly associated with this outcome.


CONCLUSIONS
After implementing the ODSF, there was less dissimilarity between patients' and physicians' DSC than expected by chance than before. Implementing the ODSF was also found to be associated with the difference between patients' and physicians' DSC. The physician level explained a significant amount of the variance in this outcome, thus emphasizing the importance of an intervention at this level.
Légaré
France
F
Department of Family Medicine, Laval University, Hôpital St. François d'Assise, Québec, Canada. france.legare@mfa.ulaval.ca
O'Connor
Annette M
AM
Graham
Ian D
ID
Wells
Georges A
GA
Tremblay
Stéphane
S
D000328:Adult; D003220:Conflict, Psychological; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D012959:Socioeconomic Factors