title: Training family physicians in shared decision making for the use of antibiotics for acute respiratory infections: a pilot clustered randomized controlled trial.
abstract: BACKGROUND
  Experts estimate that the prevalence of antibiotics use exceeds the prevalence of bacterial acute respiratory infections (ARIs).
  
  
  OBJECTIVE
  To develop, adapt and validate DECISION+ and estimate its impact on the decision of family physicians (FPs) and their patients on whether to use antibiotics for ARIs.
  
  
  METHODS
  Two-arm parallel clustered pilot randomized controlled trial.
  
  
  METHODS
  Four family medicine groups were randomized to immediate DECISION+ participation (the experimental group) or delayed DECISION+ participation (the control group). Thirty-three FPs and 459 patients participated.
  
  
  METHODS
  DECISION+ is a multiple-component, continuing professional development program in shared decision making that addresses the use of antibiotics for ARIs.
  
  
  METHODS
  Throughout the pilot trial, DECISION+ was adapted in response to participant feedback. After the consultation, patients and FPs independently self-reported the decision (immediate use, delayed use, or no use of antibiotics) and its quality. Agreement between their decisional conflict was assessed. Two weeks later, patients assessed their decisional regret and health status.
  
  
  RESULTS
  Compared to the control group, the experimental group reduced its immediate use of antibiotics (49 vs. 33% absolute difference = 16%; P = 0.08). Decisional conflict agreement was stronger in the experimental group (absolute difference of Pearson's r = 0.26; P = 0.06). Decisional regret and perceptions of the quality of the decision and of health status in the two groups were similar.
  
  
  CONCLUSIONS
  DECISION+ was developed successfully and appears to reduce the use of antibiotics for ARIs without affecting patients' outcomes. A larger trial is needed to confirm this observation.
authors.affiliation: Research Centre of the Centre Hospitalier Universitaire de Québec, Québec, QC, Canada. france.legare@mfa.ulaval.ca
authors.forename: France
authors.initials: F
authors.lastname: Légaré
authors.forename: Michel
authors.initials: M
authors.lastname: Labrecque
authors.forename: Annie
authors.initials: A
authors.lastname: LeBlanc
authors.forename: Merlin
authors.initials: M
authors.lastname: Njoya
authors.forename: Claudine
authors.initials: C
authors.lastname: Laurier
authors.forename: Luc
authors.initials: L
authors.lastname: Côté
authors.forename: Gaston
authors.initials: G
authors.lastname: Godin
authors.forename: Robert L
authors.initials: RL
authors.lastname: Thivierge
authors.forename: Annette
authors.initials: A
authors.lastname: O'Connor
authors.forename: Sylvie
authors.initials: S
authors.lastname: St-Jacques
mesh_terms: D000208:Acute Disease; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation / Q000379:methods*; D010817:Physician-Patient Relations; D010821:Physicians, Family; D010865:Pilot Projects; D010818:Practice Patterns, Physicians'; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D012959:Socioeconomic Factors
chemical_list: D000900:Anti-Bacterial Agents