A questionnaire based study to investigate the extent of shared decision making during consultations in out-of-hours primary care

Abstract

Out-of-hours (OOH) primary care physicians (PCPs) provide urgent primary care when in-hours practices are closed. During consultations, several decisions may be made about treatments, investigations or referral. In modern healthcare systems, there is growing emphasis on involving patients in decisions about their care. It is generally agreed that this should be achieved through the process of ‘shared decision making’ (SDM). It is also understood that patients’ vary in their preferences for involvement in decision making. In OOH care, the patient and clinician are not known to one another, there are little or no medical records and patients tend to present with acute problems. These factors mean there is no pre-existing relationship or implicit knowledge in the encounter which increases the necessity for eliciting and incorporating values and preferences into the consultation through a SDM approach. It is not known currently whether decisions being made in an OOH setting are being shared with patients or not. In other healthcare settings, studies suggest that the degree of patient involvement is generally low, especially in the absence of tools to promote SDM. This research will, for the first time in the urgent primary care setting, establish the degree to which patients want to be involved in decision making and how much they feel involved in the decisions made about their health during consultations with OOH clinicians.