Toward Shared Decision Making: Using the OPTION Scale to Analyze Resident-Patient Consultations in Family Medicine

Purpose Do residents in family medicine practice share decision making with patients during consultations? This study used a validated scale to score family medicine residents' shared decision-making (SDM) skills in primary care consultations and to determine whether residents' demographic characteristics were correlated with their scores. Method Between January 2009 and April 2010 at two Canadian academic health centers, the authors recruited unique dyads of patients consulting in primary care and family medicine residents. They recorded, transcribed, and assessed consultations using the Observing Patient Involvement in Decision Making (OPTION) scale, which measures 12 SDM-specific behaviors on a scale of 0% to 100% (high score = better SDM). They calculated descriptive and inferential statistics for the scores. Results From 212 eligible residents, the authors recruited 152 unique patient-resident dyads (participation rate = 75%): 68 dyads from 13 clinics in London, Ontario, and 84 from six family medicine units in Quebec City, Quebec. The mean global OPTION score was 24% +/- 8%; the mean score for each of the 12 items ranged from 4% to 37%. Five of the 12 behaviors obtained a mean score below a minimal attempt is made to exhibit the behavior (i.e., <25%). There was a positive correlation between the score and the duration of the consultation (r = 0.24, P = .003), with longer consultations producing higher scores. Conclusions Participating family medicine residents have not integrated SDM behaviors, which may also pertain to residencies elsewhere. Interventions are required to foster family medicine residents' practice of SDM.