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Impact of the Ottawa Decision Support Framework on the Agreement and the Difference between Patients' and Physicians' Decisional Conflict

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  • France Légaré

    (Department of Family Medicine, Laval University, Hôpital St. François d'Assise, 10, rue de l'Espinay, Québec G1L 3L5, Canada france.legare@mfa.ulaval.ca.)

  • Annette M. O'Connor
  • Ian D. Graham
  • Georges A. Wells

    (University of Ottawa, Ottawa, Ontario, Canada)

  • Stéphane Tremblay

Abstract

Background . The Ottawa Decision Support Framework (ODSF) provides a process that facilitates shared decision making. Objective . To assess the impact of implementing the ODSF on the agreement and the difference between patients' and physicians' decisional conflict scores. Design . In total, 120 physicians and 903 patients enrolled in this before-and-after study. Implementation of the ODSF was composed of an interactive workshop, feedback, and a reminder at the point of care. The Decisional Conflict Scale (DCS) was completed by physicians and patients after a clinical encounter. Results . The intraclass correlation coefficient was–0.205 ± 0.096 (95% confidence interval [CI]= – 0.224 to –0.186) before implementing the ODSF and– 0.013 ± 0.114 (95% CI = – 0.036 to 0.009) after. At the patient level, the following factors were significantly associated with the difference between the patients' and physicians' DCS: unemployed (P = 0.023), implementing the ODSF (P = 0.008), high school degree (P = 0.04), male (P = 0.03), and unilateral role in decision making (P = 0.03). At the physician level, provincial committee (P = 0.001), national committee (P = 0.045), clinical site (P = 0.016), reluctance to share uncertainty (P = 0.023), and anxiety due to uncertainty (P = 0.017) were significantly associated with this outcome. Conclusion . After implementing the ODSF, there was less dissimilarity between patients' and physicians' DSC than expected by chance than before. Implementing the ODSF was also found to be associated with the difference between patients' and physicians' DSC. The physician level explained a significant amount of the variance in this outcome, thus emphasizing the importance of an intervention at this level.

Suggested Citation

  • France Légaré & Annette M. O'Connor & Ian D. Graham & Georges A. Wells & Stéphane Tremblay, 2006. "Impact of the Ottawa Decision Support Framework on the Agreement and the Difference between Patients' and Physicians' Decisional Conflict," Medical Decision Making, , vol. 26(4), pages 373-390, July.
    • Handle: RePEc:sae:medema:v:26:y:2006:i:4:p:373-390
    DOI: 10.1177/0272989X06290492
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    References listed on IDEAS

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    1. Charles, Cathy & Gafni, Amiram & Whelan, Tim, 1997. "Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango)," Social Science & Medicine, Elsevier, vol. 44(5), pages 681-692, March.
    2. Mead, Nicola & Bower, Peter, 2000. "Patient-centredness: a conceptual framework and review of the empirical literature," Social Science & Medicine, Elsevier, vol. 51(7), pages 1087-1110, October.
    3. Starfield, B. & Wray, C. & Hess, K. & Gross, R. & Birk, P.S. & D'Lugoff, B.C., 1981. "The influence of patient-practitioner agreement on outcome of care," American Journal of Public Health, American Public Health Association, vol. 71(2), pages 127-132.
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