Assessing the Implementation of Shared Decision-Making in Primary Care: A Study With Unannounced Standardized Patients.

RATIONALE, AIMS, AND

OBJECTIVES

Shared decision making (SDM) is widely endorsed in clinical guidelines, yet clinicians may not use it consistently across different clinical problems. This study explores how SDM is influenced by the clinical topic under discussion.

METHODS

Using unannounced standardized patients (USPs), we observed how resident physicians engaged in SDM during new patient visits involving both gastroesophageal reflux disease (GERD) and smoking cessation. Audio recordings were evaluated using the validated Observer OPTION-5 tool.

RESULTS

SDM scores were significantly higher in smoking cessation discussions than in GERD management. Residents more frequently integrated patient preferences when discussing smoking but gave more information when managing GERD.

CONCLUSIONS

Residents appeared to adjust their SDM behaviors based on topic, suggesting context-dependent application. Educational interventions should address this variability and promote balanced use of SDM across routine and behaviorally complex decisions.