Inconsistencies in patient perceptions and observer ratings of shared decision making: the case of colorectal cancer screening.
OBJECTIVE
To compare patient-reported and observer-rated shared decision making (SDM) use for colorectal cancer (CRC) screening and evaluate patient, physician and patient-reported relational communication factors associated with patient-reported use of shared CRC screening decisions.


METHODS
Study physicians are salaried primary care providers. Patients are insured, aged 50-80 and due for CRC screening. Audio-recordings from 363 primary care visits were observer-coded for elements of SDM. A post-visit patient survey assessed patient-reported decision-making processes and relational communication during visit. Association of patient-reported SDM with observer-rated elements of SDM, as well as patient, physician and relational communication factors were evaluated using generalized estimating equations.


RESULTS
70% of patients preferred SDM for preventive health decisions, 47% of patients reported use of a SDM process, and only one of the screening discussions included all four elements of SDM per observer ratings. Patient report of SDM use was not associated with observer-rated elements of SDM, but was significantly associated with female physician gender and patient-reported relational communication.


CONCLUSIONS
Inconsistencies exist between patient reports and observer ratings of SDM for CRC screening.


CONCLUSIONS
Future studies are needed to understand whether SDM that is patient-reported, observer-rated or both are associated with informed and value-concordant CRC screening decisions.
Wunderlich
Tracy
T
Henry Ford Health System, Detroit, MI 48202, USA. Twunder1@hfhs.org
Cooper
Gregory
G
Divine
George
G
Flocke
Susan
S
Oja-Tebbe
Nancy
N
Stange
Kurt
K
Lafata
Jennifer Elston
JE
D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000523:psychology; D003142:Communication; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D015588:Observer Variation; D010342:Patient Acceptance of Health Care; D010358:Patient Participation; D010817:Physician-Patient Relations; D011795:Surveys and Questionnaires