Gastroenterologists' Views of Shared Decision Making for Patients with Inflammatory Bowel Disease.
BACKGROUND
There is limited information on gastroenterologists' perspectives of shared decision making (SDM) in discussions of therapeutic agents with inflammatory bowel disease (IBD) patients.


OBJECTIVE
To examine gastroenterologists' perspectives about SDM with IBD patients, using a novel statistical hybrid approach to analyze qualitative data.


METHODS
Physician interviews and online surveys were conducted from a panel of gastroenterologists in April 2012. Gastroenterologists were asked about their barriers to SDM, SDM practices, relationship to their patients, knowledge of SDM, and insights into SDM implementation. Key audio excerpts adapted from the interviews were used for moment-to-moment affect trace analysis in an online survey. Cluster analysis was used to segment gastroenterologists into mutually exclusive provider groups.


RESULTS
One hundred and six gastroenterologists completed the survey (88 % male; 55 % ≤ 50 years of age). Over three-fourths of gastroenterologists were familiar with SDM (77 %). The vast majority of gastroenterologists (80 %) tried to use a form of SDM with their patients; only 12 % stated that they have a systematic, consistent, and formally documented approach to SDM. Three unique physician clusters were identified: SDM Believers (20 %, n = 20); SDM Skeptics (47 %, n = 47); and SDM Enthusiasts (34 %, n = 34). The three key barriers to practicing SDM were lack of the following: time (74 %), reimbursement (70 %), and tools (51 %). Twenty-two percent of gastroenterologists do not currently use SDM tools.


CONCLUSIONS
Gastroenterologists lack the systematic approaches and tools for implementing SDM within their IBD practices. These data offer a foundation for future research in developing and testing SDM programs for gastroenterologists and their IBD patients.
Inflammatory Bowel Disease Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA, corey.a.siegel@hitchcock.org.
Corey A
CA
Siegel
Jennifer H
JH
Lofland
Ahmad
A
Naim
Jan
J
Gollins
Danielle M
DM
Walls
Laura E
LE
Rudder
Chuck
C
Reynolds
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D016000:Cluster Analysis; D003657:Decision Making; D005260:Female; D005762:Gastroenterology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D007349:Insurance, Health, Reimbursement; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D013997:Time Factors