title: 'They leave at least believing they had a part in the discussion': understanding decision aid use and patient-clinician decision-making through qualitative research.
abstract: OBJECTIVE
  This study explores how patient decision aids (DAs) for antihyperglycemic agents and statins, designed for use during clinical consultations, are embedded into practice, examining how patients and clinicians understand and experience DAs in primary care visits.
  
  
  METHODS
  We conducted semistructured in-depth interviews with patients (n=22) and primary care clinicians (n=19), and videorecorded consultations (n=44). Two researchers coded all transcripts. Inductive analyses guided by grounded theory led to the identification of themes. Video and interview data were compared and organized by themes.
  
  
  RESULTS
  DAs used during consultations became flexible artifacts, incorporated into existing decision making roles for clinicians (experts, authority figures, persuaders, advisors) and patients (drivers of healthcare, learners, partners). DAs were applied to different decision making steps (deliberation, bargaining, convincing, case assessment), and introduced into an existing knowledge context (participants' literacy regarding shared decision-making (SDM) and DAs).
  
  
  CONCLUSIONS
  DAs' flexible use during consultations effectively provided space for discussion, even when SDM was not achieved. DAs can be used within any decision-making model.
  
  
  CONCLUSIONS
  Clinician training in DA use and SDM practice may be needed to facilitate DA implementation and promote more ideal-type forms of sharing in decision making.
authors.affiliation: Department of Sociology and Anthropology, University Lumière Lyon 2, Bron Cedex, France. kristina.tiedje@univ-lyon2.fr.
authors.forename: Kristina
authors.initials: K
authors.lastname: Tiedje
authors.forename: Nathan D
authors.initials: ND
authors.lastname: Shippee
authors.forename: Anna M
authors.initials: AM
authors.lastname: Johnson
authors.forename: Priscilla M
authors.initials: PM
authors.lastname: Flynn
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Finnie
authors.forename: Juliette T
authors.initials: JT
authors.lastname: Liesinger
authors.forename: Carl R
authors.initials: CR
authors.lastname: May
authors.forename: Marianne E
authors.initials: ME
authors.lastname: Olson
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Ridgeway
authors.forename: Nilay D
authors.initials: ND
authors.lastname: Shah
authors.forename: Barbara P
authors.initials: BP
authors.lastname: Yawn
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003142:Communication; D003657:Decision Making; D003661:Decision Support Techniques; D003920:Diabetes Mellitus; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010358:Patient Participation; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000379:methods*; D036301:Qualitative Research; D019035:Rural Health Services / Q000458:organization & administration; D012959:Socioeconomic Factors; D019037:Urban Health Services / Q000458:organization & administration; D014741:Video Recording; D055815:Young Adult
keywords: Decision aids; Provider–patient communication; Shared decision making