Opportunities for the use of decision aids in primary care.
OBJECTIVE
Shared decision making (SDM) is part of a larger movement for patient-centered approaches to care. SDM can be facilitated through the use of decision aids (DA), which are evidence-based tools designed to transmit information on topics suitable for SDM. They are intended to facilitate the process of patients arriving at an informed, values-based choice in partnership with physicians. Research indicates that SDM and the use of DA are underutilized. This study evaluated SDM and DA in primary care.


METHODS
Adult patients presenting for chronic disease follow-up to one of four participating primary care health centers were recruited over 16 months. Visit discussions were audiorecorded, transcribed, and coded using Davis coding. Discussion comments were coded for type of SDM (with and without DA) and topics matched against two DA registries.


RESULTS
Forty-four unique patient visits were recorded. Shared decision activities on 15 topics were found in 34 discussions, across 27 (61%) of the visits. DA use did not occur in any visit. Fifteen (34%) visits included topics with peer-validated, freely available DA.


CONCLUSIONS
Even when shared decision making occurs, DAs are rarely used. Research is needed to identify and reduce barriers to using DAs in primary care.
Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA 92037-0811, USA. lhillbaird@aol.com
Linda
L
Hill
Mary-Rose
MR
Mueller
Stergios
S
Roussos
Melbourne
M
Hovell
John
J
Fontanesi
Jennifer
J
Hill
Nadia
N
Sales
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D018802:Patient-Centered Care / Q000379:methods*; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000379:methods*