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Patient-physician agreement on the content of CHD prevention discussions.


ABSTRACT: 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.

SUBMITTER: Behrend L 

PROVIDER: S-EPMC4043219 | biostudies-literature | 2011 Mar

REPOSITORIES: biostudies-literature

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Patient-physician agreement on the content of CHD prevention discussions.

Behrend Lindy L   Maymani Hossein H   Diehl Megan M   Gizlice Ziya Z   Cai Jianwen J   Sheridan Stacey L SL  

Health expectations : an international journal of public participation in health care and health policy 20110301


<h4>Background</h4>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.<h4>Objective</h4>To determine patient-physician agreement on content and outcomes of coronary heart disease (CHD) prevention discussions.<h4>Design</h4>Cross-sectional survey nested within a randomized CHD prevention study.<h4>Setting and participants</h4>Univ  ...[more]

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