Informed Decision Making in Outpatient Practice: Time to Get Back to Basics
CONTEXT Many clinicians have called for an increased emphasis on the patient's role in clinical decision making. However, little is known about the extent to which physicians foster patient involvement in decision making, particularly in routine office practice. OBJECTIVE To characterize the na...
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| Veröffentlicht in: | JAMA : the journal of the American Medical Association 1999-12, Vol.282 (24), p.2313-2320 |
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| creator | Braddock III, Clarence H Edwards, Kelly A Hasenberg, Nicole M Laidley, Tracy L Levinson, Wendy |
| description | CONTEXT Many clinicians have called for an increased emphasis on the patient's
role in clinical decision making. However, little is known about the extent
to which physicians foster patient involvement in decision making, particularly
in routine office practice. OBJECTIVE To characterize the nature and completeness of informed decision making
in routine office visits of both primary care physicians and surgeons. DESIGN Cross-sectional descriptive evaluation of audiotaped office visits during
1993. SETTING AND PARTICIPANTS A total of 1057 encounters among 59 primary care physicians (general
internists and family practitioners) and 65 general and orthopedic surgeons;
2 to 12 patients were recruited from each physician's community-based private
office. MAIN OUTCOME MEASURES Analysis of audiotaped patient-physician discussions for elements of
informed decision making, using criteria that varied with the level of decision
complexity: basic (eg, laboratory test), intermediate (eg, new medication),
or complex (eg, procedure). Criteria for basic decisions included discussion
of the nature of the decision and asking the patient to voice a preference;
other categories had criteria that were progressively more stringent. RESULTS The 1057 audiotaped encounters contained 3552 clinical decisions. Overall,
9.0% of decisions met our definition of completeness for informed decision
making. Basic decisions were most often completely informed (17.2%), while
no intermediate decisions were completely informed, and only 1 (0.5%) complex
decision was completely informed. Among the elements of informed decision
making, discussion of the nature of the intervention occurred most frequently
(71%) and assessment of patient understanding least frequently (1.5%). CONCLUSIONS Informed decision making among this group of primary care physicians
and surgeons was often incomplete. This deficit was present even when criteria
for informed decision making were tailored to expect less extensive discussion
for decisions of lower complexity. These findings signal the need for efforts
to encourage informed decision making in clinical practice. |
| doi_str_mv | 10.1001/jama.282.24.2313 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_proquest_miscellaneous_69378632</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><ama_id>192233</ama_id><sourcerecordid>47576813</sourcerecordid><originalsourceid>FETCH-LOGICAL-a376t-1c1d643981d026691ba76e1326e344c882bd8b5c7c0841a95763f6519c510eda3</originalsourceid><addsrcrecordid>eNpd0U1LxDAQBuAgiq4fd71IEPHWNZNp09Sb6-eioof1XKZpKlm37dq0B_-9kV1ZcC4TmIchvMPYMYgxCAGXc6ppLLUcy3gsEXCLjSBBHWGS6W02EiLTURrreI_tez8XoQDTXbYHQkHwesSepk3VdrUt-a01zru24S_06ZoP7hr-OvRL6p1tev7WkemdsVd85mrL-5Y_2J5PyHz-vifknfGHbKeihbdH637A3u_vZjeP0fPrw_Tm-jkiTFUfgYFSxZhpKIVUKoOCUmUBpbIYx0ZrWZS6SExqhI6BsiRVWKkEMpOAsCXhAbtY7V127ddgfZ_Xzhu7WFBj28HnKsNUK5QBnv2D83bomvC3XAKglpiKgE7XaChCDvmyczV13_lfRgGcrwF5Q4uqoyYktXESZIwqsJMVCzfZDDMpEfEHzAt6oQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>211382370</pqid></control><display><type>article</type><title>Informed Decision Making in Outpatient Practice: Time to Get Back to Basics</title><source>MEDLINE</source><source>American Medical Association Journals</source><creator>Braddock III, Clarence H ; Edwards, Kelly A ; Hasenberg, Nicole M ; Laidley, Tracy L ; Levinson, Wendy</creator><creatorcontrib>Braddock III, Clarence H ; Edwards, Kelly A ; Hasenberg, Nicole M ; Laidley, Tracy L ; Levinson, Wendy</creatorcontrib><description>CONTEXT Many clinicians have called for an increased emphasis on the patient's
role in clinical decision making. However, little is known about the extent
to which physicians foster patient involvement in decision making, particularly
in routine office practice. OBJECTIVE To characterize the nature and completeness of informed decision making
in routine office visits of both primary care physicians and surgeons. DESIGN Cross-sectional descriptive evaluation of audiotaped office visits during
1993. SETTING AND PARTICIPANTS A total of 1057 encounters among 59 primary care physicians (general
internists and family practitioners) and 65 general and orthopedic surgeons;
2 to 12 patients were recruited from each physician's community-based private
office. MAIN OUTCOME MEASURES Analysis of audiotaped patient-physician discussions for elements of
informed decision making, using criteria that varied with the level of decision
complexity: basic (eg, laboratory test), intermediate (eg, new medication),
or complex (eg, procedure). Criteria for basic decisions included discussion
of the nature of the decision and asking the patient to voice a preference;
other categories had criteria that were progressively more stringent. RESULTS The 1057 audiotaped encounters contained 3552 clinical decisions. Overall,
9.0% of decisions met our definition of completeness for informed decision
making. Basic decisions were most often completely informed (17.2%), while
no intermediate decisions were completely informed, and only 1 (0.5%) complex
decision was completely informed. Among the elements of informed decision
making, discussion of the nature of the intervention occurred most frequently
(71%) and assessment of patient understanding least frequently (1.5%). CONCLUSIONS Informed decision making among this group of primary care physicians
and surgeons was often incomplete. This deficit was present even when criteria
for informed decision making were tailored to expect less extensive discussion
for decisions of lower complexity. These findings signal the need for efforts
to encourage informed decision making in clinical practice.</description><identifier>ISSN: 0098-7484</identifier><identifier>EISSN: 1538-3598</identifier><identifier>DOI: 10.1001/jama.282.24.2313</identifier><identifier>PMID: 10612318</identifier><identifier>CODEN: JAMAAP</identifier><language>eng</language><publisher>Chicago, IL: American Medical Association</publisher><subject>Bioethics ; Biological and medical sciences ; Colorado ; Complementary Therapies ; Comprehension ; Cross-Sectional Studies ; Decision Making ; Disclosure ; Family Practice ; General Surgery ; Humans ; Informed Consent ; Medical procedures ; Medical sciences ; Miscellaneous ; Observer Variation ; Office Visits ; Oregon ; Outpatients ; Patient Participation ; Physician-Patient Relations ; Physicians ; Practice Patterns, Physicians ; Private Practice ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Risk Assessment ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Teaching. Deontology. Ethics. Legislation ; Uncertainty</subject><ispartof>JAMA : the journal of the American Medical Association, 1999-12, Vol.282 (24), p.2313-2320</ispartof><rights>2000 INIST-CNRS</rights><rights>Copyright American Medical Association Dec 22/29, 1999</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jama/articlepdf/10.1001/jama.282.24.2313$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.282.24.2313$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,314,780,784,3340,27924,27925,76489,76492</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1212436$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10612318$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Braddock III, Clarence H</creatorcontrib><creatorcontrib>Edwards, Kelly A</creatorcontrib><creatorcontrib>Hasenberg, Nicole M</creatorcontrib><creatorcontrib>Laidley, Tracy L</creatorcontrib><creatorcontrib>Levinson, Wendy</creatorcontrib><title>Informed Decision Making in Outpatient Practice: Time to Get Back to Basics</title><title>JAMA : the journal of the American Medical Association</title><addtitle>JAMA</addtitle><description>CONTEXT Many clinicians have called for an increased emphasis on the patient's
role in clinical decision making. However, little is known about the extent
to which physicians foster patient involvement in decision making, particularly
in routine office practice. OBJECTIVE To characterize the nature and completeness of informed decision making
in routine office visits of both primary care physicians and surgeons. DESIGN Cross-sectional descriptive evaluation of audiotaped office visits during
1993. SETTING AND PARTICIPANTS A total of 1057 encounters among 59 primary care physicians (general
internists and family practitioners) and 65 general and orthopedic surgeons;
2 to 12 patients were recruited from each physician's community-based private
office. MAIN OUTCOME MEASURES Analysis of audiotaped patient-physician discussions for elements of
informed decision making, using criteria that varied with the level of decision
complexity: basic (eg, laboratory test), intermediate (eg, new medication),
or complex (eg, procedure). Criteria for basic decisions included discussion
of the nature of the decision and asking the patient to voice a preference;
other categories had criteria that were progressively more stringent. RESULTS The 1057 audiotaped encounters contained 3552 clinical decisions. Overall,
9.0% of decisions met our definition of completeness for informed decision
making. Basic decisions were most often completely informed (17.2%), while
no intermediate decisions were completely informed, and only 1 (0.5%) complex
decision was completely informed. Among the elements of informed decision
making, discussion of the nature of the intervention occurred most frequently
(71%) and assessment of patient understanding least frequently (1.5%). CONCLUSIONS Informed decision making among this group of primary care physicians
and surgeons was often incomplete. This deficit was present even when criteria
for informed decision making were tailored to expect less extensive discussion
for decisions of lower complexity. These findings signal the need for efforts
to encourage informed decision making in clinical practice.</description><subject>Bioethics</subject><subject>Biological and medical sciences</subject><subject>Colorado</subject><subject>Complementary Therapies</subject><subject>Comprehension</subject><subject>Cross-Sectional Studies</subject><subject>Decision Making</subject><subject>Disclosure</subject><subject>Family Practice</subject><subject>General Surgery</subject><subject>Humans</subject><subject>Informed Consent</subject><subject>Medical procedures</subject><subject>Medical sciences</subject><subject>Miscellaneous</subject><subject>Observer Variation</subject><subject>Office Visits</subject><subject>Oregon</subject><subject>Outpatients</subject><subject>Patient Participation</subject><subject>Physician-Patient Relations</subject><subject>Physicians</subject><subject>Practice Patterns, Physicians</subject><subject>Private Practice</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>Risk Assessment</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Teaching. Deontology. Ethics. Legislation</subject><subject>Uncertainty</subject><issn>0098-7484</issn><issn>1538-3598</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1999</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpd0U1LxDAQBuAgiq4fd71IEPHWNZNp09Sb6-eioof1XKZpKlm37dq0B_-9kV1ZcC4TmIchvMPYMYgxCAGXc6ppLLUcy3gsEXCLjSBBHWGS6W02EiLTURrreI_tez8XoQDTXbYHQkHwesSepk3VdrUt-a01zru24S_06ZoP7hr-OvRL6p1tev7WkemdsVd85mrL-5Y_2J5PyHz-vifknfGHbKeihbdH637A3u_vZjeP0fPrw_Tm-jkiTFUfgYFSxZhpKIVUKoOCUmUBpbIYx0ZrWZS6SExqhI6BsiRVWKkEMpOAsCXhAbtY7V127ddgfZ_Xzhu7WFBj28HnKsNUK5QBnv2D83bomvC3XAKglpiKgE7XaChCDvmyczV13_lfRgGcrwF5Q4uqoyYktXESZIwqsJMVCzfZDDMpEfEHzAt6oQ</recordid><startdate>19991222</startdate><enddate>19991222</enddate><creator>Braddock III, Clarence H</creator><creator>Edwards, Kelly A</creator><creator>Hasenberg, Nicole M</creator><creator>Laidley, Tracy L</creator><creator>Levinson, Wendy</creator><general>American Medical Association</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7QL</scope><scope>7QP</scope><scope>7TK</scope><scope>7TS</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope></search><sort><creationdate>19991222</creationdate><title>Informed Decision Making in Outpatient Practice: Time to Get Back to Basics</title><author>Braddock III, Clarence H ; Edwards, Kelly A ; Hasenberg, Nicole M ; Laidley, Tracy L ; Levinson, Wendy</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a376t-1c1d643981d026691ba76e1326e344c882bd8b5c7c0841a95763f6519c510eda3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1999</creationdate><topic>Bioethics</topic><topic>Biological and medical sciences</topic><topic>Colorado</topic><topic>Complementary Therapies</topic><topic>Comprehension</topic><topic>Cross-Sectional Studies</topic><topic>Decision Making</topic><topic>Disclosure</topic><topic>Family Practice</topic><topic>General Surgery</topic><topic>Humans</topic><topic>Informed Consent</topic><topic>Medical procedures</topic><topic>Medical sciences</topic><topic>Miscellaneous</topic><topic>Observer Variation</topic><topic>Office Visits</topic><topic>Oregon</topic><topic>Outpatients</topic><topic>Patient Participation</topic><topic>Physician-Patient Relations</topic><topic>Physicians</topic><topic>Practice Patterns, Physicians</topic><topic>Private Practice</topic><topic>Public health. Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>Risk Assessment</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Teaching. Deontology. Ethics. Legislation</topic><topic>Uncertainty</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Braddock III, Clarence H</creatorcontrib><creatorcontrib>Edwards, Kelly A</creatorcontrib><creatorcontrib>Hasenberg, Nicole M</creatorcontrib><creatorcontrib>Laidley, Tracy L</creatorcontrib><creatorcontrib>Levinson, Wendy</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Physical Education Index</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>JAMA : the journal of the American Medical Association</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Braddock III, Clarence H</au><au>Edwards, Kelly A</au><au>Hasenberg, Nicole M</au><au>Laidley, Tracy L</au><au>Levinson, Wendy</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Informed Decision Making in Outpatient Practice: Time to Get Back to Basics</atitle><jtitle>JAMA : the journal of the American Medical Association</jtitle><addtitle>JAMA</addtitle><date>1999-12-22</date><risdate>1999</risdate><volume>282</volume><issue>24</issue><spage>2313</spage><epage>2320</epage><pages>2313-2320</pages><issn>0098-7484</issn><eissn>1538-3598</eissn><coden>JAMAAP</coden><abstract>CONTEXT Many clinicians have called for an increased emphasis on the patient's
role in clinical decision making. However, little is known about the extent
to which physicians foster patient involvement in decision making, particularly
in routine office practice. OBJECTIVE To characterize the nature and completeness of informed decision making
in routine office visits of both primary care physicians and surgeons. DESIGN Cross-sectional descriptive evaluation of audiotaped office visits during
1993. SETTING AND PARTICIPANTS A total of 1057 encounters among 59 primary care physicians (general
internists and family practitioners) and 65 general and orthopedic surgeons;
2 to 12 patients were recruited from each physician's community-based private
office. MAIN OUTCOME MEASURES Analysis of audiotaped patient-physician discussions for elements of
informed decision making, using criteria that varied with the level of decision
complexity: basic (eg, laboratory test), intermediate (eg, new medication),
or complex (eg, procedure). Criteria for basic decisions included discussion
of the nature of the decision and asking the patient to voice a preference;
other categories had criteria that were progressively more stringent. RESULTS The 1057 audiotaped encounters contained 3552 clinical decisions. Overall,
9.0% of decisions met our definition of completeness for informed decision
making. Basic decisions were most often completely informed (17.2%), while
no intermediate decisions were completely informed, and only 1 (0.5%) complex
decision was completely informed. Among the elements of informed decision
making, discussion of the nature of the intervention occurred most frequently
(71%) and assessment of patient understanding least frequently (1.5%). CONCLUSIONS Informed decision making among this group of primary care physicians
and surgeons was often incomplete. This deficit was present even when criteria
for informed decision making were tailored to expect less extensive discussion
for decisions of lower complexity. These findings signal the need for efforts
to encourage informed decision making in clinical practice.</abstract><cop>Chicago, IL</cop><pub>American Medical Association</pub><pmid>10612318</pmid><doi>10.1001/jama.282.24.2313</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0098-7484 |
| ispartof | JAMA : the journal of the American Medical Association, 1999-12, Vol.282 (24), p.2313-2320 |
| issn | 0098-7484 1538-3598 |
| language | eng |
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| source | MEDLINE; American Medical Association Journals |
| subjects | Bioethics Biological and medical sciences Colorado Complementary Therapies Comprehension Cross-Sectional Studies Decision Making Disclosure Family Practice General Surgery Humans Informed Consent Medical procedures Medical sciences Miscellaneous Observer Variation Office Visits Oregon Outpatients Patient Participation Physician-Patient Relations Physicians Practice Patterns, Physicians Private Practice Public health. Hygiene Public health. Hygiene-occupational medicine Risk Assessment Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Teaching. Deontology. Ethics. Legislation Uncertainty |
| title | Informed Decision Making in Outpatient Practice: Time to Get Back to Basics |
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