Impact of a Decision aid on Perceptions of Shared Decision-Making in the Primary Care Management of Patients with Subacromial Pain Syndrome: a two-phased multi-methods study
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Background
Subacromial pain syndrome (SAPS) is the most common shoulder pain condition in primary care). Although exercise is the recommended first-line treatment, the absence of a universally superior option underscores the need for personalized care facilitated by shared decision-making (SDM). Despite the importance of SDM is increasingly recognized, its application in SAPS care remains poorly understood. The primary aim of this study was to explore the influence of a decision aid on patient and observer perceptions of SDM in the primary care management of patients with SAPS. Furthermore, the study aimed to explore correlations between patients’ and observers’ ratings of SDM.
Methods
We conducted a multi-methods study including observations of consenting patients with SAPS in their clinical consultations with clinicians from four Danish primary care practices, using OPTION-12. Additionally, we gathered patients’ perceptions of SDM two weeks after the consultation using an online survey using the 3-item CollaboRATE questionnaire and the 9-item Shared Decision-Making Questionnaire (SDM-Q-9). We observed consultations both with and without the introduction of a decision aid tailored to support the management of patients with SAPS.
Results
Thirty-four consultations were observed (16 with the decision aid, 18 without). Without the decision aid, the mean (SD) OPTION-12 score was low 10.5 + 3.3, and the median (IQR) CollaboRATE and mean (SD) SDM-Q-9 scores were 5 (IQR = 1.3) and 22.2 + 7.5, respectively. We observed higher scores in the consultations with the decision aid; the mean (SD, range) OPTION-12 score statistically significantly increased to 22.7 (6.87, 5-32), and the median (IQR) CollaboRATE and mean (SD) SDM-Q-9 scores were 6.5 (1.4) and 30.6 + 8.4, respectively. There was a positive and statistically significant correlation between patients’ and observers’ ratings of OPTION-12 and SDM-Q-9 scores across both phases. No significant correlation was found between CollaboRATE, OPTION-12, and SDM-Q-9 in either phase.
Conclusion
A decision aid significantly improved observer- and patient-rated SDM in primary care consultations for patients with SAPS. Observer-rated SDM scores more than doubled with the decision aid, and patients reported higher levels of SDM. These findings highlight the potential of decision aids to enhance SDM in SAPS care.
