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

Abstract

BACKGROUND: Subacromial pain syndrome (SAPS) is the most common shoulder pain condition in primary care. Despite the importance of shared decision-making (SDM) being increasingly recognised, 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, and secondarily to explore correlations between these ratings in the primary care management of patients with SAPS. 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. We gathered patients' perceptions of SDM 2 weeks after the consultation using the CollaboRATE questionnaire and Shared Decision-Making Questionnaire (SDM-Q-9). We observed consultations with and without the introduction of a decision aid tailored to support the management of patients. RESULTS: Thirty-four consultations were observed (16 with and 18 without the decision aid). Without the aid, the mean (SD) OPTION-12 score was 10.5 (3.3), while the median (IQR) CollaboRATE and mean (SD) SDM-Q-9 scores were 5 (1.3) and 22.2 (7.5), respectively. With the aid, scores significantly increased: OPTION-12 to 22.7 (6.87, range 5-32), CollaboRATE to 6.5 (1.4), and SDM-Q-9 to 30.6 (8.4). Patients' and observers' OPTION-12 and SDM-Q-9 scores correlated significantly across both phases, but no significant correlation was found between CollaboRATE, OPTION-12, and SDM-Q-9 scores 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.