Open AccessFostering Patient Choice Awareness and Presenting Treatment Options Neutrally: A Randomized Trial to Assess the Effect on Perceived Room for Involvement in Decision Making
Author(s) -
Arwen H. Pieterse,
Kim Brandes,
Jessica de Graaf,
Joyce E de Boer,
Na Labrie,
André Knops,
Cornelia F Allaart,
J.E.A. Portielje,
Willem Jan W. Bos,
Anne M. Stiggelbout
Publication year - 2021
Publication title -
medical decision making
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.393
H-Index - 103
eISSN - 1552-681X
pISSN - 0272-989X
DOI - 10.1177/0272989x211056334
Subject(s) - vignette , randomized controlled trial , preference , medicine , health literacy , patient participation , family medicine , decision aids , patient satisfaction , physical therapy , psychology , clinical psychology , medline , health care , social psychology , alternative medicine , nursing , political science , law , economics , microeconomics , economic growth , pathology
Purpose Shared decision making calls for clinician communication strategies that aim to foster choice awareness and to present treatment options neutrally, such as by not showing a preference. Evidence for the effectiveness of these communication strategies to enhance patient involvement in treatment decision making is lacking. We tested the effects of 2 strategies in an online randomized video-vignettes experiment.Methods We developed disease-specific video vignettes for rheumatic disease, cancer, and kidney disease showcasing a physician presenting 2 treatment options. We tested the strategies in a 2 (choice awareness communication present/absent) by 2 (physician preference communication present/absent) randomized between-subjects design. We asked patients and disease-naïve participants to view 1 video vignette while imagining being the patient and to report perceived room for involvement (primary outcome), understanding of treatment information, treatment preference, satisfaction with the consultation, and trust in the physician (secondary outcomes). Differences across experimental conditions were assessed using 2-way analyses of variance.Results A total of 324 patients and 360 disease-naïve respondents participated (mean age, 52 ± 14.7 y, 54% female, 56% lower educated, mean health literacy, 12 ± 2.1 on a 3–15 scale). The results showed that choice awareness communication had a positive (M present = 5.2 v. M absent = 5.0, P = 0.042, η 2 partial = 0.006) and physician preference communication had no (M present = 5.0 v. M absent = 5.1, P = 0.144, η 2 partial = 0.003) significant effect on perceived room for involvement in decision making. Physician preference communication steered patients toward preferring that treatment option (M present = 4.7 v. M absent = 5.3, P = 0.006, η 2 partial = 0.011). The strategies had no significant effect on understanding, satisfaction, or trust.Conclusions This is the first experimental evidence for a small effect of fostering choice awareness and no effect of physician preference on perceived room to participate in decision making. Physician preference steered patients toward preferring that option.