SRFP031: Different levels of willingness for shared decision making among resident physicians

Michael Alexander Ferrante; Amrita Sandhu, BSc; Vinita D'Souza, MSc; Roland Grad, MD, CCFP, FCFP; Glyn Elwyn, MD, PhD, BA, MSc; Gabrielle Stevens

Abstract

Context: The willingness of Family Medicine residents to engage in shared decision making (SDM) has not been previously assessed. Objective: To assess the willingness of family medicine residents to engage in SDM in the context of preventive health care. Study Design: Single group cohort. Setting: Department of Family Medicine, McGill University, Montreal. Population: By email and online, all 200 residents (102 R1, 98 R2) were offered participation before the intervention. Intervention/Instrument: On May 26, 2021, we delivered a lecture followed immediately by a skills development workshop. To start this educational intervention, residents answered demographic questions and the 7-item incorpoRATE measure. For each item, residents were asked to respond using a 0-10 scale. Each resident’s total measure score is the average of all items (possible range 0-10). Outcome Measures: Baseline (pre-intervention) incorpoRATE scores. Results: Of the 73 residents in attendance, 66 (90%) consented and completed all questions in the baseline measure. The mean total incorpoRATE score was 7.0±1.0; range 4.9 to 9.1. Second year resident scores (n=21) were significantly higher than first year resident scores (7.4±1.2 versus 6.8±0.8, p<0.002). Male and female scores were similar. Compared to a high stakes situation, in a low stakes situation residents would feel more comfortable providing care when a patient chooses an option that is not aligned with their clinical recommendation (6.9±1.9 versus 3.8±2.5). Conclusions: Willingness to engage in SDM varies greatly, as indicated by the range in scores. Second year residents showed a greater willingness to engage in SDM. The “stakes” of a clinical situation appear to make a difference in resident comfort when thinking about the provision of clinical care that involves SDM. Future work will assess the impact of the educational intervention on resident physician willingness for SDM.
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Jack Westfall
jwestfall@aafp.org 11/21/2021

Very interesting research. Great work. Thanks

Lauren Oshman
laoshman@med.umich.edu 11/22/2021

Thank you for this! We actually used INCORPORATE in an OSCE on selecting breast cancer imaging in a 40 year old patient a few years ago and I found it really effective for feedback giving and norming behaviors.

Pierre Pluye
11/22/2021

Great poster, congratulations:)! You said " Future work will assess the impact of the educational intervention on resident physician willingness for SDM". Naive question/comment: I would be curious to know more about the professional context (e.g., "setting readiness for implementing SDM" if this existed) as the peers, the mentors and practices of the clinical setting may have a great impact on individual residents' SDM willingness (e.g., is it feasible to compare clinics with high vs low level of readiness).

Diane Harper
harperdi@med.umich.edu 11/22/2021

You might survey graduated residents to see if SDM increases once they have been in practice longer? Present your results in Phoenix next year! Thank you for sharing your work with NAPCRG!

William R. Phillips
wphllps@uw.edu 11/22/2021

Attractive and effective poster. Very important research question.I will look forward to longitudinal data that show changes over time in individual trainees. Is the key variable "high stakes" or is it "high uncertainty."  Thanks for sharing your work here at NAPCRG. - Bill Phillips

Andy Pasternak
avpiv711@sbcglobal.net 11/28/2021

Well done poster! Love the layout and how you presented your data!

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