 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Sabrina T. Wong, RN, PhD1, George W. Saba, PhD2, Dean Schillinger, MD3, Clifford Wilson, BA3, Carol P. Somkin, PhD4, LaVera M. Crawley, MD5, Thomas Denberg, MD, PhD6, Alicia Fernandez, MD3, Yessenia Rivera, BA1, and Kevin Grumbach, MD7. (1) Medical Effectiveness Research Center for Diverse Populations, University of California San Francisco, Box 0856, 3333 California Street, Suite 335, San Francisco, CA 94143, 415-514-3355, sabrina@itsa.ucsf.edu, (2) Department of Behavioral Sciences, University of California, San Francisco, San Francisco General Hospital, 1001 Potrero Avenue, Building 80, Ward 83, San Francisco, CA 94110, (3) Department of General Internal Medicine, San Francisco General Hospital, University of California, San Francisco, 1001 Potrero Avenue, Box 1364, Building 90, San Francisco, CA 94110, (4) Division of Research, Kaiser Foundation Research Institute, 3505 Broadway, Oakland, CA 94611, (5) Center for Biomedical Ethics/Department of Medicine, Stanford University, 701 Welch Road, #1105, Palo Alto, CA 94305, (6) Department of Medicine/Division of General Internal Medicine, University of California, San Francisco, 400 Parnassus, Box 0320, San Francisco, CA 94143, (7) Department of Family and Community Medicine, University of California, San Francisco, San Francisco General Hospital, Ward 83, 1001 Potrero Ave, San Francisco, CA 94110
Significance. Shared Decision Making (SDM) refers to a process in which both doctor and patient exchange information, preferences, and decisions about treatment. Preliminary evidence suggests that SDM is considered important for quality of care and leads to leads to greater trust, satisfaction, and improved outcomes. Deficits in SDM might therefore be one of several key factors contributing to racial/ethnic disparities in health. Specific Aims. The specific aim of this study was to elicit patient and clinician perspectives on SDM and their respective explanations regarding how and why decisions were (or were not) made during actual clinic visits. Methods. Using a multi-method approach, data were collected on 20 patient-physician dyads in primary care clinics at a Northern California public hospital. Patients spoke English or Spanish, had a chronic condition (e.g. diabetes, hypertension), and self-identified as African American, Latino, Filipino, or white. In addition to participant questionnaires and researcher-coded direct observations (video-tapes) of clinic visits, we employed an innovative methodology called stimulated recall that allows clinicians and patients to separately view the videotape of their clinical encounter to identify thoughts, feelings, and behaviors pertinent to the experience of the visit. Results. Stimulated recall has been especially useful in identifying the factors that both promote and impede SDM, the multidimensionality of decision making, and limitations associated with deriving this information from the use of questionnaires and direct observation alone. Implications. Stimulated recall offers a novel and powerful method for studying decision-making and other aspects of patient-centered care. It may aid research on the conditions under which provider behaviors (participatory style, warmth, information-giving, question-asking) or patient behaviors (e.g. question-asking, self disclosure, assertiveness, acceptance of advice) are related to health disparities.
Learning Objectives:
Keywords: Methodology, Decision-Making
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.