Getting to what matters for people with osteoporosis in clinical consultations with and without conversation aids: A videographic analysis.

Abstract

To evaluate if, and how, clinicians elicit and address health and medicine beliefs in osteoporosis consultations, and to evaluate the impact of a conversation aid (CA) on clinician behaviour. Secondary analysis of 107 video-recorded consultations from two trials evaluating CAs, using a bespoke coding tool to record the presence or absence of clinician shared decision-making (SDM) behaviours. In addition to descriptive statistics, Fisher's exact test examined differences between consultations with and without CAs. Clinicians framed osteoporosis as a bone density (92 %) and/or fracture risk problem (78 % overall (96 % usual care vs 62 % aided, p < 0.001)). Biopsychosocial consequences of fractures were rarely mentioned. Clinicians asked questions to elicit beliefs in 58 % of consultations, most commonly general views on medications (47 % usual care vs 26 % aided, p = 0.03). Clinicians rarely asked about beliefs related to osteoporosis (n = 3), perceived need for (n = 1), concerns about (n = 5), or practical issues (n = 6) with medication. Clinicians used persuasion techniques more commonly in aided consultations (88 % vs 64 %, p = <0.001). Patient understanding was infrequently checked (12 %). Clinicians miss opportunities to support patients to get the best from osteoporosis medications by tailoring communications to address necessity, beliefs, concerns and practicalities. We need better methods for supporting clinicians in eliciting patient beliefs about osteoporosis and the medications recommended to treat it, including their need, safety, and practical issues.