Semistructured interviews regarding patients' perceptions of Choosing Wisely and shared decision-making: an Australian study

Jacqueline Allen; Richard King; Stacy K Goergen; Angela Melder; Naama Neeman; Annemarie Hadley; Alison M Hutchinson

doi:10.1136/bmjopen-2019-031831

Semistructured interviews regarding patients' perceptions of Choosing Wisely and shared decision-making: an Australian study

BMJ Open. 2019 Aug 28;9(8):e031831. doi: 10.1136/bmjopen-2019-031831.

Authors

Jacqueline Allen¹, Richard King², Stacy K Goergen^{3

4}, Angela Melder⁵, Naama Neeman⁶, Annemarie Hadley², Alison M Hutchinson⁷

Affiliations

¹ School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia jacqui.allen@monash.edu.
² Monash Health, Clayton, Victoria, Australia.
³ Imaging, Monash University, Clayton, Victoria, Australia.
⁴ Radiology, Monash Health, Clayton, Victoria, Australia.
⁵ Centre for Clinical Effectiveness, Monash Health, Clayton, Victoria, Australia.
⁶ Children's Cancer Foundation, Hudson Institute of Medical Research, Clayton, Victoria, Australia.
⁷ School of Nursing and Midwifery; Centre for Quality and Patient Safety Monash Health Partnership, Monash Health, Deakin University, Geelong, Victoria, Australia.

Abstract

Objectives: This study aimed to examine how patients perceive shared decision-making regarding CT scan referral and use of the five Choosing Wisely questions with their general practitioner (GP).

Design: This is a qualitative exploratory study using semistructured interviews.

Setting: This study was conducted in a large metropolitan public healthcare organisation in urban Australia.

Participants: Following purposive sampling, 20 patients and 2 carers participated. Patient participants aged 18 years or older were eligible if they were attending the healthcare organisation for a CT scan and referred by their GP. Carers/family were eligible to participate when they were in the role of an unpaid carer and were aged 18 years or older. Participants were required to speak English sufficiently to provide informed consent. Participants with cognitive impairment were excluded.

Findings: Eighteen interviews were conducted with the patient only. Two interviews were conducted with the patient and the patient's carer. Fourteen participants were female. Five themes resulted from the thematic analysis: (1) needing to know, (2) questioning doctors is not necessary, (3) discussing scans is not required, (4) uncertainty about questioning and (5) valuing the Choosing Wisely questions. Participants reported that they presented to their GP with a health problem that they needed to understand and address. Participants accepted their GPs decision to prescribe a CT scan to identify the nature of their problem. They reported ambivalence about engaging in shared decision-making with their doctor, although many participants reported valuing the Choosing Wisely questions.

Conclusions: Shared decision-making is an important principle underpinning Choosing Wisely. Practice implementation requires understanding patients' motivations to engage in shared decision-making with a focus on attitudes, beliefs, knowledge and emotions. Systems-level support and education for healthcare practitioners in effective communication is important. However, this needs to emphasise communication with patients who have varying degrees of motivation to engage in shared decision-making and Choosing Wisely.

Keywords: Choosing Wisely; patients’ perspectives; semi-structured interviews; shared decision-making.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Australia
Communication*
Decision Making, Shared*
Female
Health Knowledge, Attitudes, Practice*
Humans
Interviews as Topic
Male
Middle Aged
Patient Participation*
Professional-Patient Relations*
Qualitative Research
Risk Assessment
Unnecessary Procedures