To investigate family physicians’ views on factors that make health care
decisions difficult for patients, interventions family physicians use to
support patients making decisions, and interventions proposed by the
Ottawa Decision Support Framework (ODSF).
Thirteen group discussions.
Five family practice units.
One hundred twenty family physicians.
The multifaceted implementation intervention consisted of feedback from
participants, a reminder at point of care, and an interactive workshop.
During the workshop, family physicians were asked about their views on 2
videos both showing the concluding phase of a simulated clinical encounter
with a woman facing a decision about hormone therapy. One video showed usual
care; the other showed use of the ODSF process and related tools. Content
was analyzed using observations by non-participants, field notes, material
collected from participants during workshops, evaluation forms completed at
the end of workshops, and comments written on exit questionnaires from the
MAIN OUTCOME MEASURES
Family physicians’ views on the types of difficult decisions their patients
face, the factors that make decisions difficult for patients, the
interventions family physicians use to support patients’ decisions, and the
interventions proposed by the ODSF.
The 2 most frequently cited factors making decisions difficult for patients
were experiencing uncertainty and fears about adverse outcomes. Before being
introduced to the ODSF, participants had used mostly information-related
strategies to provide decision support. After learning about the ODSF,
participants overwhelmingly identified assessing patients’ values as a
priority. At the end of the workshop, the 5 changes in practice participants
most frequently intended to make were, in order of importance, to assess
patients’ values, to ask about patients’ preferred role in decision making,
to screen for decisional conflict, to assess support or undue pressure on
patients, and to increase patients’ involvement in decision making.
The ODSF process and related tools have the potential to broaden family
physicians’ views on supporting patients facing difficult decisions.