How does decision complexity affect shared decision making? An analysis of patient-provider antiretroviral initiation dialogue.
Wynne Callon, Somnath Saha, Ira B Wilson and 7 others
PMID 28012679WHAT IT FOUND
Only two ART initiation dialogues fully met shared decision making criteria.
Providers discussed more elements when starting treatment was less clear, but fewer elements when they wanted ART.
Key findings
01Only two dialogues fully met shared decision making criteria, and none of the intermediate or complex decisions met the standard.
02The mean number of criteria fulfilled rose with decision complexity: basic 1.2, intermediate 2.5, and complex 4.6.
03Dialogues fulfilled more criteria when providers were ambivalent about ART (mean 3.8) than when providers wanted ART (mean 1.8).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only 24 patient-provider dialogues were analysed, and the authors state the sample was too small for statistical conclusions. The recordings were a snapshot in a longer relationship, so important SDM elements may have been discussed in other visits. The patients were mostly engaged in HIV care and had long-term relationships with providers, so results may not apply to patients less connected to care. Audio recording may have changed how patients and providers talked, although the authors cite prior work suggesting little effect. The coding scheme was modified by the investigators, so the results depend on their decisions about what counted as full, partial, or fulfilled SDM.
Declared interests
The supplied text does not include an author conflict-of-interest or funding declaration. The metadata lists research support from U.S. government sources and NIH extramural support.
The easy way to misread this
Do not read the higher mean criteria in complex decisions as proof that providers did shared decision making well. Only two dialogues fully met the criteria, and the sample was too small for statistical conclusions.