Sharing decisions increases patient satisfaction

Medical Tribune June 2008 P4
David Brill

A simple system that promotes shared decisionmaking has been shown to improve patient satisfaction without affecting their cardiovascular risk.

Patients whose physicians adopted the system during an initial consultation also participated more in the decision-making process and expressed less decisional regret 6 months later.

“It seems they think their doctor takes their problems more seriously,” said Dr. Tanya Krones
from Phillips-University Marburg in Germany, lead researcher of a randomized controlled trial which tested the decision aid in 1,132 patients.

“We were really astonished that from just one consultation shaped in this way, we saw this big difference,” she added.

The system, known as ARRIBAHerz, has already been adopted in some parts of Germany. Krones estimates that around 1,000 physicians have begun to implement the decision aid into practice since the trial was completed.

Participating doctors were trained to follow a script of six decision-making steps which included
calculating and explaining the patient’s risk, addressing their expectations and agreeing on a course of action. Additional materials were also introduced into practice, such as summary sheets for the patient which depicted their individual risk using smiley faces.

Patient satisfaction was assessed directly after consultation using the Patient Participation Scale. The difference in score between the groups was .8 (P<.001). At 6 month follow-up the mean decrease in cardiovascular risk, as calculated using the Framingham system, was three percent for the intervention group and 3.33 percent for the control group (P=.31). Nineteen intervention patients (3.5 percent) and 22 control patients (3.7 percent) experienced a severe cardiovascular event during this period. Krones noted that some doctors were initially reluctant to use the system in high-risk patients, as providing decision-making authority to these patients could result in them making irrational choices and ultimately straying from the guidelines. The comparable decrease in risk suggests that this was not the case, she said, but she acknowledged the need for longer term follow-up. Previous decision aids have tended to focus on providing information for patients to read in their own time rather than attempting to influence the behavior of physicians during consultations, added Krones. ARRIBA-Herz was developed over 3 years in consultation with more than 200 family physicians. The results of the trial were published in The Annals of Family Medicine.