Open AccessPatient–physician agreement on the content of CHD prevention discussions
Author(s) -
Behrend Lindy,
Maymani Hossein,
Diehl Megan,
Gizlice Ziya,
Cai Jianwen,
Sheridan Stacey L.
Publication year - 2011
Publication title -
health expectations
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.314
H-Index - 74
eISSN - 1369-7625
pISSN - 1369-6513
DOI - 10.1111/j.1369-7625.2010.00614.x
Subject(s) - medicine , family medicine , kappa , cohen's kappa , limiting , health care , mechanical engineering , philosophy , linguistics , machine learning , computer science , engineering , economics , economic growth
Background Little is known about agreement between patients and physicians on content and outcomes of clinical discussions. A common perception of content and outcomes may be desirable to optimize decision making and clinical care. Objective To determine patient–physician agreement on content and outcomes of coronary heart disease (CHD) prevention discussions. Design Cross‐sectional survey nested within a randomized CHD prevention study. Setting and participants University internal medicine clinic; 24 physicians and 157 patients. Methods Following one clinic visit, we surveyed patients and physicians on discussion content, decision making and final decisions about CHD prevention. For comparison, we audio‐recorded, transcribed and coded 20 patient–physician visits. We calculated percent agreement between patient/physician reports, patient/transcription reports and physician/transcription reports. We calculated Cohen’s kappas to compare patient/physician perspectives. Results Patients and physicians agreed on whether CHD was discussed in 130 visits (83%; kappa = 0.55; 95% CI 0.40–0.70). When discussions occurred, they agreed about discussion content (pros versus cons) in 53% of visits (kappa = 0.15; 95% CI −0.01–0.30) and physicians’ recommendations in 73% (kappa = 0.44; 95% CI 0.28–0.66). Patients and physicians agreed on final decisions to take medication in 78% (kappa = 0.58; 95% CI 0.45–0.71) and change lifestyle in 69% (kappa = 0.38; 95% CI 0.24–0.53). They agreed less often, 43% (kappa = 0.13; 95% CI −0.11–0.37) about degree of involvement in decision making. Audio‐recorded results were similar, but showed very low agreement between transcripts and patients’ and physicians’ self‐report on discussion content and decision making. Conclusions Disagreements about clinical discussions and decision making may be common. Future work is needed to determine: how widespread such agreements are; whether they impact clinical outcomes; and the relative importance of the subjective experience versus objective steps of shared decision making.