Shared decision making does not influence physicians against clinical practice guidelines

PLoS One. 2013 Apr 24;8(4):e62537. doi: 10.1371/journal.pone.0062537. Print 2013.

Abstract

Background: While shared decision making (SDM) and adherence to clinical practice guidelines (CPGs) are important, some believe they are incompatible. This study explored the mutual influence between physicians' intention to engage in SDM and their intention to follow CPGs.

Methods: Embedded within a clustered randomized trial to assess the impact of training physicians in SDM about using antibiotics to treat acute respiratory tract infections, this study evaluated physicians' intentions to both engage in SDM and follow CPGs. A self-administered questionnaire based on the theory of planned behavior evaluated both behavioral intentions and their respective determinants (attitude, subjective norm and perceived behavioral control) at study entry and exit. We used path analysis to explore the relationships between the intentions. We conducted statistical analyses using the maximum likelihood method and the variance-covariance matrix. Goodness of fit indices encompassed the chi-square statistic, the comparative fit index and the root mean square error of approximation.

Results: We analyzed 244 responses at entry and 236 at exit. In the control group, at entry we observed that physicians' intention to engage in SDM (r = 0, t = 0.03) did not affect their intention to follow CPGs; however, their intention to follow CPGs (r = -0.31 t = -2.82) did negatively influence their intention to engage in SDM. At exit, neither behavioral intention influenced the other. In the experimental group, at entry neither behavioral intention influenced the other; at exit, the intention to engage in SDM still did not influence the intention to use CPGs, although the intention to follow CPGs (r = -0.15 t = -2.02) slightly negatively influenced the intention to engage in SDM, but this was not clinically significant.

Conclusion: Physicians' intention to engage in SDM does not affect their intention to adopt CPGs even after SDM training. Physicians' intention to adopt CPGs had no clinically significant influence on intention to engage in SDM.

Trial registration: ClinicalTrials.gov NCT01116076.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Attitude of Health Personnel
  • Decision Making*
  • Female
  • Humans
  • Intention
  • Male
  • Middle Aged
  • Physicians / psychology*
  • Physicians, Family / psychology
  • Practice Guidelines as Topic*
  • Practice Patterns, Physicians'*

Associated data

  • ClinicalTrials.gov/NCT01116076

Grant support

This study was funded by grant from the Conseil du médicament du Québec/Fonds de la recherche en santé du Québec. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.