Patient factors that influence clinicians' decision making in self-management support: A clinical vignette study.
OBJECTIVE
Self-management support is an integral part of current chronic care guidelines. The success of self-management interventions varies between individual patients, suggesting a need for tailored self-management support. Understanding the role of patient factors in the current decision making of health professionals can support future tailoring of self-management interventions. The aim of this study is to identify the relative importance of patient factors in health professionals' decision making regarding self-management support.


METHODS
A factorial survey was presented to primary care physicians and nurses. The survey consisted of clinical vignettes (case descriptions), in which 11 patient factors were systematically varied. Each care provider received a set of 12 vignettes. For each vignette, they decided whether they would give this patient self-management support and whether they expected this support to be successful. The associations between respondent decisions and patient factors were explored using ordered logit regression.


RESULTS
The survey was completed by 60 general practitioners and 80 nurses. Self-management support was unlikely to be provided in a third of the vignettes. The most important patient factor in the decision to provide self-management support as well as in the expectation that self-management support would be successful was motivation, followed by patient-provider relationship and illness perception. Other factors, such as depression or anxiety, education level, self-efficacy and social support, had a small impact on decisions. Disease, disease severity, knowledge of disease, and age were relatively unimportant factors.


CONCLUSIONS
This is the first study to explore the relative importance of patient factors in decision making and the expectations regarding the provision of self-management support to chronic disease patients. By far, the most important factor considered was patient's motivation; unmotivated patients were less likely to receive self-management support. Future tailored interventions should incorporate strategies to enhance motivation in unmotivated patients. Furthermore, care providers should be better equipped to promote motivational change in their patients.
University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands.
Irene D
ID
Bos-Touwen
University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands.
Jaap C A
JC
Trappenburg
VUMC, EMGO Research Institute, Amsterdam, The Netherlands.
Ineke
I
van der Wulp
University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands.
Marieke J
MJ
Schuurmans
University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands.
Niek J
NJ
de Wit
D000328:Adult; D000066491:Clinical Decision-Making; D003430:Cross-Sectional Studies; D019468:Disease Management; D005260:Female; D058005:General Practitioners; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009726:Nurses; D016017:Odds Ratio; D010361:Patients; D010820:Physicians; D012648:Self Care; D011795:Surveys and Questionnaires