Patient-physician agreement on the content of CHD prevention discussions.
BACKGROUND
Little is known about agreement between patients and physicians on content and outcomes of clinical discussions. A common perception of content and outcomes may be desirable to optimize decision making and clinical care.


OBJECTIVE
To determine patient-physician agreement on content and outcomes of coronary heart disease (CHD) prevention discussions.


METHODS
Cross-sectional survey nested within a randomized CHD prevention study.


METHODS
University internal medicine clinic; 24 physicians and 157 patients.


METHODS
Following one clinic visit, we surveyed patients and physicians on discussion content, decision making and final decisions about CHD prevention. For comparison, we audio-recorded, transcribed and coded 20 patient-physician visits. We calculated percent agreement between patient/physician reports, patient/transcription reports and physician/transcription reports. We calculated Cohen's kappas to compare patient/physician perspectives.


RESULTS
Patients and physicians agreed on whether CHD was discussed in 130 visits (83%; kappa = 0.55; 95% CI 0.40-0.70). When discussions occurred, they agreed about discussion content (pros versus cons) in 53% of visits (kappa = 0.15; 95% CI -0.01-0.30) and physicians' recommendations in 73% (kappa = 0.44; 95% CI 0.28-0.66). Patients and physicians agreed on final decisions to take medication in 78% (kappa = 0.58; 95% CI 0.45-0.71) and change lifestyle in 69% (kappa = 0.38; 95% CI 0.24-0.53). They agreed less often, 43% (kappa = 0.13; 95% CI -0.11-0.37) about degree of involvement in decision making. Audio-recorded results were similar, but showed very low agreement between transcripts and patients' and physicians' self-report on discussion content and decision making.


CONCLUSIONS
Disagreements about clinical discussions and decision making may be common. Future work is needed to determine: how widespread such agreements are; whether they impact clinical outcomes; and the relative importance of the subjective experience versus objective steps of shared decision making.
Behrend
Lindy
L
Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC 27599, USA. lindy_behrend@med.unc.edu
Maymani
Hossein
H
Diehl
Megan
M
Gizlice
Ziya
Z
Cai
Jianwen
J
Sheridan
Stacey L
SL
D000328:Adult; D003327:Coronary Disease / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D010817:Physician-Patient Relations; D012959:Socioeconomic Factors