title: Training family physicians in shared decision-making to reduce the overuse of antibiotics in acute respiratory infections: a cluster randomized trial.
abstract: BACKGROUND
  Few interventions have proven effective in reducing the overuse of antibiotics for acute respiratory infections. We evaluated the effect of DECISION+2, a shared decision-making training program, on the percentage of patients who decided to take antibiotics after consultation with a physician or resident.
  
  
  METHODS
  We performed a randomized trial, clustered at the level of family practice teaching unit, with 2 study arms: DECISION+2 and control. The DECISION+2 training program included a 2-hour online tutorial followed by a 2-hour interactive seminar about shared decision-making. The primary outcome was the proportion of patients who decided to use antibiotics immediately after consultation. We also recorded patients' perception that shared decision-making had occurred. Two weeks after the initial consultation, we assessed patients' adherence to the decision, repeat consultation, decisional regret and quality of life.
  
  
  RESULTS
  We compared outcomes among 181 patients who consulted 77 physicians in 5 family practice teaching units in the DECISION+2 group, and 178 patients who consulted 72 physicians in 4 family practice teaching units in the control group. The percentage of patients who decided to use antibiotics after consultation was 52.2% in the control group and 27.2% in the DECISION+2 group (absolute difference 25.0%, adjusted relative risk 0.48, 95% confidence interval 0.34-0.68). DECISION+2 was associated with patients taking a more active role in decision-making (Z = 3.9, p < 0.001). Patient outcomes 2 weeks after consultation were similar in both groups.
  
  
  CONCLUSIONS
  The shared decision-making program DECISION+2 enhanced patient participation in decision-making and led to fewer patients deciding to use antibiotics for acute respiratory infections. This reduction did not have a negative effect on patient outcomes 2 weeks after consultation. ClinicalTrials.gov trial register no. NCT01116076.
authors: Research Centre of the Centre Hospitalier Universitaire de Québec, Québec, Canada. france.legare@mfa.ulaval.ca
authors: France
authors: F
authors: Légaré
authors: Michel
authors: M
authors: Labrecque
authors: Michel
authors: M
authors: Cauchon
authors: Josette
authors: J
authors: Castel
authors: Stéphane
authors: S
authors: Turcotte
authors: Jeremy
authors: J
authors: Grimshaw
mesh_terms: D000208:Acute Disease; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D003142:Communication; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000193:education* / Q000523:psychology; D012141:Respiratory Tract Infections / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents