AB0813-PC Shared decision making at the family-health unit: patient’s perspective
Authors: M. Cuziol, T. D. Baumgratz, R. Battisti, A. C. R. Janini, R. A. Levy, A. Gafni, M. M. Abreu
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Shared decision making (SDM) has been advocated as the preferred form of decision making over the past two decades. Literature has shown discrepancies among all health stakeholders' understanding about shared-decision making concept. <h3>Objectives</h3> Evaluate primary care patients' understanding of SDM concept in a Brazilian town and describe their willingness to be involved in their own healthcare plan. Also, examine patients' opinion regarding the role of multiprofessional team in the quality of care. <h3>Methods</h3> This is a quantitative study. All patients registered in a primary care unit were asked to participate. A questionnaire covering demographic and clinical data, and patients opinions regarding the role of the multiprofessional team on the quality of care was applied. Three scenarios that presented different models of clinical encounter (paternalistic, informed and shared decision making) were presented. Outcome measures were the answers from the questionnaire and the answers regarding the scenarios. Statistical analysis was performed through measures of central tendency and dispersion. The associations among the categories were conducted by correspondence analyses (multivariate analysis). This study was approved by Research Ethics Committee. <h3>Results</h3> We interviewed 278 patients, 50% Caucasian, 79% female, 24% between 20 and 29 years old and 42% with incomplete primary education. 78% of the respondents consider that multidisciplinary work team is important to improve patient's knowledge regarding the disease they had. When asked about patient's involvement in the health plan decisions, 78.4% prefer to decide about the treatment with the doctor. Despite of this result, when asked about the meaning of SDM, paternalistic and informed decision-making, 83% defined SDM and informed decision making as similar concepts. A correspondence analysis plot illustrated that females, mestizos, and aged between 30 and 39 year olds were associated with more willingness to share the decisions with the physician. There was no association between comprehension about decision-making and having a chronic disease. <h3>Conclusions</h3> The level of understanding of the difference between informed, shared and paternalistic decision-making is not clear from this sample. This study demonstrated that patients in primary care consider that a multi-professional teamwork is significant to improve patient's knowledge regarding their disease. <h3>References</h3> Abreu, MM; Gafni, A; Ferraz, MB. <b>Development and testing of a decision board to help clinicians present treatment options to lupus nephritis patients in Brazil.</b> Arthritis and Rheumatism, v. 61, p. 37-45, 2009. Abreu, MM ; Battisti, R ; Martins, RS ; Baumgratz, TD ; Cuziol, M. <b>Shared decision making in Brazil: history and current discussion.</b> German Journal for Evidence and Quality in Health Care (2008), v. 105, p. 240-244, 2011. Charles, C; Gafni, A; Whelan, T. <b>Shared Decision-making in the Medical Encounter: What Does That Mean?</b> (Or it takes at least Two to Tango). Soc Sci Med. 1997;44(5):681-92. Fenton, WS. <b>Shared decision making: a model for the physician relationship in the 21<sup>st</sup> century?</b> Acta Psychiatr Scand. 2003;107(6):401-2 Moumijd, N; Gafni, A; Brémond, A; Carrère, MO. <b>Shared Decision Making in the Medical Encounter: Are We All Talking about the Same Thing?</b> Med Decis Making. 2007;27(5):539-46. <h3>Disclosure of Interest</h3> None Declared