Objectives Describe what Family Medicine (FM) residents consider to be high versus low stakes situations when engaging patients in shared decision making (SDM), and whether overdiagnosis is a factor in their mind.
Method A sequential explanatory mixed methods study was conducted with 54 first year FM residents at McGill University who attended an academic-half day session about SDM. Quantitative: Immediately before this session, residents were asked to complete a 7-item version of IncorpoRATE, a measure of clinician willingness to engage in SDM. Qualitative: Using extreme case-sampling based on IncorpoRATE responses, 16 residents were interviewed. We asked what situations they considered to be high versus low stakes for SDM in the context of decision making in primary care. Integration: Qualitative and quantitative findings were compared and combined to elucidate resident perspectives on decisional stakes. Interview transcripts were analyzed for any mention of the potential role that overdiagnosis plays in shared decision making, in relation to situations perceived as high stakes by residents.
Results Overall, residents were willing to engage in SDM, with mean willingness scores of 7.32 [1.52]. However, resident willingness to engage in shared decision making varied widely, from 4.38 to 9.19 out of a maximum score of 10. Qualitative findings revealed variation in what types of decisions residents considered low and high stakes for SDM. For example: Mammography screening for breast cancer was considered a low stakes situation. No consensus existed as to whether PSA screening for prostate cancer was a high or low stakes situation. Symptomatic patients who declined diagnostic testing was described as a high stakes situation.
Conclusions Our sample of family medicine residents did not refer to the concept of overdiagnosis when discussing their perceptions of the stakes for healthcare decision making. This suggests postgraduate medical education at our university must be re-examined in relation to improving learning on this topic. More work is needed to understand the stakes of situations for prioritizing SDM in Family Medicine.
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