title: Clinicians' involvement of patients in decision making. A video based comparison of their behavior in public vs. private practice.
abstract: BACKGROUND
  Little is known about the extent to which Peruvian physicians seek to involve patients in shared decision making, or about the variation in these efforts across different settings.
  
  
  OBJECTIVE
  To measure the extent to which Peruvian clinicians involve their patients in decision making and to explore the differences between clinicians' behavior in private vs. public practice.
  
  
  METHODS
  Videographic analysis.
  
  
  METHODS
  Seven academic physicians who provided care to patients in a public and a private setting participate in this study. All the encounters in both settings were filmed on one random day of February 2012.
  
  
  METHODS
  Two raters, working independently and in duplicate used the 12-item OPTION scale to quantify the extent of physician effort to involve patients in shared decision making (with 0 indicating no effort and 100 maximum possible effort) in 58 video recordings of usual clinical encounters in private and public practice.
  
  
  RESULTS
  The mean OPTION score was 14.3 (SD 7.0). Although the OPTION score in the private setting (mean 16.5, SD 7.3) was higher than in the public setting (mean 12.3 SD 6.1) this difference was not statistically significant (p = .09).
  
  
  CONCLUSIONS
  Peruvian academic physicians in this convenience sample barely sought to involve their patients in shared decision making. Additional studies are required to confirm these results which suggest that patient-centered care remains an unfulfilled promise and a source of inequity within and across the private and the public sectors in Peru.
authors.affiliation: Unidad de Conocimiento y Evidencia (CONEVID), Department of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru. nicolemongilardi@gmail.com
authors.forename: Nicole
authors.initials: N
authors.lastname: Mongilardi
authors.forename: Víctor
authors.initials: V
authors.lastname: Montori
authors.forename: Alejandro
authors.initials: A
authors.lastname: Riveros
authors.forename: Antonio
authors.initials: A
authors.lastname: Bernabé-Ortiz
authors.forename: Javier
authors.initials: J
authors.lastname: Loza
authors.forename: Germán
authors.initials: G
authors.lastname: Málaga
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003142:Communication; D003657:Decision Making; D003695:Delivery of Health Care; D005260:Female; D006268:Health Facilities; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D018802:Patient-Centered Care; D010568:Peru; D010817:Physician-Patient Relations; D010820:Physicians; D015203:Reproducibility of Results; D014741:Video Recording