title: EXACKTE(2): exploiting the clinical consultation as a knowledge transfer and exchange environment: a study protocol.
abstract: BACKGROUND
  While the evidence suggests that the way physicians provide information to patients is crucial in helping patients decide upon a course of action, the field of knowledge translation and exchange (KTE) is silent about how the physician and the patient influence each other during clinical interactions and decision-making. Consequently, based on a novel relationship-centered model, EXACKTE(2) (EXploiting the clinicAl Consultation as a Knowledge Transfer and Exchange Environment), this study proposes to assess how patients and physicians influence each other in consultations.
  
  
  METHODS
  We will employ a cross-sectional study design involving 300 pairs of patients and family physicians from two primary care practice-based research networks. The consultation between patient and physician will be audio-taped and transcribed. Following the consultation, patients and physicians will complete a set of questionnaires based on the EXACKTE(2) model. All questionnaires will be similar for patients and physicians. These questionnaires will assess the key concepts of our proposed model based on the essential elements of shared decision-making (SDM): definition and explanation of problem; presentation of options; discussion of pros and cons; clarification of patient values and preferences; discussion of patient ability and self-efficacy; presentation of doctor knowledge and recommendation; and checking and clarifying understanding. Patients will be contacted by phone two weeks later and asked to complete questionnaires on decisional regret and quality of life. The analysis will be conducted to compare the key concepts in the EXACKTE(2) model between patients and physicians. It will also allow the assessment of how patients and physicians influence each other in consultations.
  
  
  CONCLUSIONS
  Our proposed model, EXACKTE(2), is aimed at advancing the science of KTE based on a relationship process when decision-making has to take place. It fosters a new KTE paradigm by putting forward a relationship-centered perspective and has the potential to reveal unknown mechanisms that underline effective KTE in clinical contexts. This will result in better understanding of the mechanisms that may promote a new generation of knowledge transfer strategies.
authors.affiliation: Research Center of the Centre Hospitalier Universitaire de Québec, Québec, Canada. france.legare@mfa.ulaval.ca
authors.forename: France
authors.initials: F
authors.lastname: Légaré
authors.forename: Moira
authors.initials: M
authors.lastname: Stewart
authors.forename: Dominick
authors.initials: D
authors.lastname: Frosch
authors.forename: Jeremy
authors.initials: J
authors.lastname: Grimshaw
authors.forename: Michel
authors.initials: M
authors.lastname: Labrecque
authors.forename: Martine
authors.initials: M
authors.lastname: Magnan
authors.forename: Mathieu
authors.initials: M
authors.lastname: Ouimet
authors.forename: Michel
authors.initials: M
authors.lastname: Rousseau
authors.forename: Dawn
authors.initials: D
authors.lastname: Stacey
authors.forename: Trudy
authors.initials: T
authors.lastname: van der Weijden
authors.forename: Glyn
authors.initials: G
authors.lastname: Elwyn