Shared decision making in consultations for hypertension
Qualitative study in general practice
Bibliographic Data
| ID | 19506686 |
|---|---|
| Authors | Rachel Johnson (0000-0002-9408-4924, Centre for Academic Primary Care, Population Health Sciences Bristol Medical School Bristol UK, corresponding author), K Turner (0000-0002-6375-2918, At Bristol), Gene Feder (0000-0002-7890-3926, Centre for Academic Primary Care, Population Health Sciences Bristol Medical School Bristol UK), Helen Cramer (0000-0001-5989-2638, Centre for Academic Primary Care, Population Health Sciences Bristol Medical School Bristol UK) |
| Year | 2021 |
| Volume | 24 |
| Issue | 3 |
| Pages | 917-929 |
| Publication date | 2021-06-01 |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Health Expectations (JOURNAL) |
| Journal identifiers | ISSN: 1369-6513 • E-ISSN: 1369-7625 |
| Publisher | Wiley (PUBLISHER • GB) |
| DOI | 10.1111/hex.13234 |
| PMID | 33818879 |
| OpenAlex | W3141649848 |
| Language | EN |
| References cited | 36 |
BACKGROUND: Hypertension is mainly managed in primary care. Shared decision making is widely recommended as an approach to treatment decision making. However, no studies have investigated; in detail, what happens during primary care consultations for hypertension. AIM: To understand patients' and clinicians' experience of shared decision making for hypertension in primary care, in order to propose how it might be better supported. DESIGN: Longitudinal qualitative study. SETTING: Five general practices in south-west England. METHOD: Interviews with a purposive sample of patients with hypertension, and with the health-care practitioners they consulted, along with observations of clinical consultations, for up to 6 appointments. Interviews and consultations were audio-recorded and observational field notes taken. Data were analysed thematically. RESULTS: Forty-six interviews and 18 consultations were observed, with 11 patients and nine health-care practitioners (five GPs, one pharmacist and three nurses). Little shared decision making was described by participants or observed. Often patients' understanding of their hypertension was limited, and they were not aware there were treatment choices. Consultations provided few opportunities for patients and clinicians to reach a shared understanding of their treatment choices. Opportunities for patients to engage in choices were limited by structured consultations and the distribution of decisions across consultations. CONCLUSION: For shared decision making to be better supported, consultations need to provide opportunities for patients to learn about their condition, to understand that there are treatment choices, and to discuss these choices with clinicians. PATIENT OR PUBLIC CONTRIBUTION: A patient group contributed to the design of this study
Family medicine · General practice · Health care · Observational study · Patient participation · Pharmacist · Primary care · Qualitative research · Shared care · Dementia and Cognitive Impairment Research · Healthcare Systems and Technology · Medicine · Nursing · Patient-Provider Communication in Healthcare · Psychology · Pharmacy
Decision aids for people facing health treatment or screening decisions
Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013
The co-dependency concept
Knowledge is not power for patients
Systematic review of the Hawthorne effect
Barriers and facilitators to implementing shared decision-making in clinical practice
Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015
An integrative model of shared decision making in medical encounters
Interventions to support shared decision making for hypertension
The meaning of patient involvement and participation in health care consultations
Sample Size in Qualitative Interview Studies
Shared decision-making - Rhetoric and reality
The Constant Comparative Method of Qualitative Analysis
Distributed decision making
| Highly cited | No |
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