Opportunities for addressing gaps in primary care shared decision-making with technology: a mixed-methods needs assessment

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dc.contributor.authorMisra, Anjali J.
dc.contributor.authorOng, Shawn Y.
dc.contributor.authorGokhale, Arjun
dc.contributor.authorKhan, Sameer
dc.contributor.authorMelnick, Edward R.
dc.contributor.funderAgency for Healthcare Research and Qualityen
dc.date.accessioned2019-09-25T10:40:51Z
dc.date.available2019-09-25T10:40:51Z
dc.date.issued2019-07-31
dc.description.abstractObjectives: To analyze current practices in shared decision-making (SDM) in primary care and perform a needs assessment for the role of information technology (IT) interventions. Materials and Methods: A mixed-methods study was conducted in three phases: (1) ethnographic observation of clinical encounters, (2) patient interviews, and (3) physician interviews. SDM was measured using the validated OPTION scale. Semistructured interviews followed an interview guide (developed by our multidisciplinary team) informed by the Traditional Decision Conflict Scale and Shared Decision Making Questionnaire. Field notes were independently coded and analyzed by two reviewers in Dedoose. Results: Twenty-four patient encounters were observed in 3 diverse practices with an average OPTION score of 57.2 (0–100 scale; 95% confidence interval [CI], 51.8–62.6). Twenty-two patient and 8 physician interviews were conducted until thematic saturation was achieved. Cohen’s kappa, measuring coder agreement, was 0.42. Patient domains were: establishing trust, influence of others, flexibility, frustrations, values, and preferences. Physician domains included frustrations, technology (concerns, existing use, and desires), and decision making (current methods used, challenges, and patients’ understanding). Discussion: Given low SDM observed, multiple opportunities for technology to enhance SDM exist based on specific OPTION items that received lower scores, including: (1) checking the patient’s preferred information format, (2) asking the patient's preferred level of involvement in decision making, and (3) providing an opportunity for deferring a decision. Based on data from interviews, patients and physicians value information exchange and are open to technologies that enhance communication of care options. Conclusion: Future primary care IT platforms should prioritize the 3 quantitative gaps identified to improve physician–patient communication and relationships. Additionally, SDM tools should seek to standardize common workflow steps across decisions and focus on barriers to increasing adoption of effective SDM tools into routine primary care.en
dc.description.sponsorshipAgency for Healthcare Research and Quality (grant number K08HS021271)en
dc.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.articleidooz027en
dc.identifier.citationMisra, A. J., Ong, S. Y., Gokhale, A., Khan, S. and Melnick, E. R. (2019) 'Opportunities for addressing gaps in primary care shared decision-making with technology: a mixed-methods needs assessment', JAMIA Open, ooz027, [In press]. (9pp.) DOI: 10.1093/jamiaopen/ooz027en
dc.identifier.doi10.1093/jamiaopen/ooz027en
dc.identifier.eissn2574-2531
dc.identifier.endpage9en
dc.identifier.journaltitleJAMIA Openen
dc.identifier.startpage1en
dc.identifier.urihttps://hdl.handle.net/10468/8616
dc.language.isoenen
dc.publisherOxford University Pressen
dc.relation.urihttps://academic.oup.com/jamiaopen/advance-article/doi/10.1093/jamiaopen/ooz027/5542029
dc.rights©The Author(s) 2018. Published by Oxford University Press on behalf of the American Medical Informatics Association. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited.en
dc.rights.urihttp://creativecommons.org/licenses/by-nc/4.0/en
dc.subjectPrimary health careen
dc.subjectDecision makingen
dc.subjectMedical informaticsen
dc.subjectPhysician-patient relationsen
dc.subjectNeeds assessmenten
dc.titleOpportunities for addressing gaps in primary care shared decision-making with technology: a mixed-methods needs assessmenten
dc.typeArticle (peer-reviewed)en
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