Perspectives of family physician educators on shared decision making in preventive health care: A Qualitative Descriptive Inquiry.

Abstract

To explore the views of family physician (FP) educators on shared decision making (SDM). Qualitative descriptive study. Individual interviews were recorded with FPs in active practice who were also educators of Family Medicine residents. Data were analyzed following the phases of practical thematic analysis. 15 practicing FP educators in a clinic setting were interviewed; nine female and six male FPs with practice experience averaging 19 years. We identified five themes, which we then grouped in two major categories: (i) Conceptual ideas about SDM and (ii) Challenges in putting SDM into practice. In the conceptual idea category: (1) Participants held different understandings of SDM and did not have consensus about when SDM should be achieved in clinical practice (difficulty conceptualizing what SDM is, understanding of SDM changes over time, SDM requires clinical equipoise). (2) Participants identified why SDM is important (patient-centred care). Themes in the putting SDM into practice category (ii) were: (3) When to engage in SDM is influenced by multiple factors (system factors, research-based evidence) as well as (4) patient factors (social or contextual factors, discordance or misalignment between doctor and patient on a specific decision, patient safety). (5) Resources and strategies are needed to put SDM into action. An inconsistent understanding of SDM among FP educators, as well as several other challenges, helps explain why SDM has been difficult to implement in practice. Physician educators will appreciate how this study unveils challenges to enhancing resident training for the use of SDM in primary care.