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108 Improving clinicians’ risk perception accuracy: is this a hidden benefit of patient decision aids?
  1. Tammy Hoffmann1,
  2. Mark Jones1,
  3. Paul Glasziou1,
  4. Elaine Beller1,
  5. Lyndal Trevena2
  1. 1Institute of Evidence-Based Healthcare, Bond University, Gold Coast, Australia
  2. 2Faculty of Medicine and Health, University of Sydney, Sydney, Australia

Abstract

Introduction It has been established that clinicians’ rarely have accurate expectations about intervention benefits and harms,1 which means effective interventions may be underused, low value interventions overused, and informed shared decision making with patients hampered. The effect of patient decision aids on the accuracy of patients’ risk perception has been studied.2 Whether aids can also improve the accuracy of clinicians’ risk perceptions has not been examined. We studied this as part of a cluster randomised trial of patient decision aids.

Methods A cluster randomised trial in Australian general practices to evaluate the impact of a brief shared decision making intervention (3 patient decision aids about antibiotic use for 3 common acute infections and video-delivered training). One of the trial’s secondary outcomes was general practitioners’ (GP) knowledge of antibiotic benefit-harm evidence; measured using a questionnaire at baseline and 12 months post-randomisation.

Results 27 general practices (13 intervention, 14 control), involving 122 GPs, participated. Significantly greater increases in antibiotic benefit-harm evidence knowledge were seen in the intervention group GPs than those in the control group in the number of correct responses to the 22 knowledge questions (mean 3.6, 95% CI 2.4–4.7, p<.001). The intervention group had lower odds of providing an over- estimate of antibiotic benefits than the control group (OR 0.24, 95% CI 0.09–0.60).

Discussion Patient decision aids may have a previously unreported benefit for clinicians as they contain a concise summary of benefit and harm evidence. Measuring clinician knowledge of benefits and harms as an outcome in future trials of patient decision aids would help to assess the replicability of this finding.

Conclusion Patient decision aids may have an under-recognised role in improving the accuracy of clinicians’ perceptions of the benefits and harms of interventions, thus helping to correct distorted perceptions and improve informed and collaborative decision-making.

References

  1. Hoffmann T, Del Mar C, JAMA Int Med. 2017;177:407–419.

  2. Stacey D, Légaré F, Lewis K, Barry MJ, Bennett CL, Eden KB, Holmes-Rovner M, Llewellyn-Thomas H, Lyddiatt A, Thomson R, Trevena L. Cochrane Database Syst Rev. 2017;(4):CD001431.

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