title: Patient-physician agreement on the content of CHD prevention discussions.
abstract: 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.
authors.affiliation: Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC 27599, USA. lindy_behrend@med.unc.edu
authors.forename: Lindy
authors.initials: L
authors.lastname: Behrend
authors.forename: Hossein
authors.initials: H
authors.lastname: Maymani
authors.forename: Megan
authors.initials: M
authors.lastname: Diehl
authors.forename: Ziya
authors.initials: Z
authors.lastname: Gizlice
authors.forename: Jianwen
authors.initials: J
authors.lastname: Cai
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Sheridan
mesh_terms: 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