On a learning curve: Interviews with clinicians using Option Grids® to facilitate SDM with patients with osteoarthritis of the knee.

The problem

Shared decision making interventions are easier to introduce if they have minimal impact on clinicians’ workloads. Option Grids have shown promise as useful tools to illustrate benefits and harms of treatment options. However, we do not have good information about how these tools are viewed by clinicians, and how they perceive patients react to them. We examined the views of clinicians about their intended, and actual, use of Option Grids within clinical consultations. Our aim was to assess the reactions of clinicians to using these tools, to anticipated challenges, and to track their views about feasibility and acceptability as they proceeded to gain experience of using the tool with multiple patients.

The approach

This qualitative interview study was embedded in a trial designed to evaluate the impact of introducing Option Grids into consultations conducted by six physiotherapists in an osteoarthritis interface clinic in Oldham, Greater Manchester. We conducted interviews with clinicians at two time points. The first, after they had viewed the Option Grid and told about its proposed use, covered the following topics: existing knowledge and attitude to shared decision making, feasibility within existing workflows, and likely patients’ reactions. The second interview was conducted after clinicians had received training to use the Option Grid and had used it with six patients each. This interview covered how the tool modified interactions with patients, whether it was a help or hindrance, their impression of patient reactions, and views about the Option Grid’s overall value and future implementation. Data were analysed thematically.

Findings

At initial interviews, the six clinicians voiced a range of concerns including prior experience that patients do not expect to be involved in decision making and that the tool would lead to increases in the duration of clinical encounters. They were concerned that patients would react negatively and feel overloaded with information. At the second interview, clinicians reported that when they started using the Option Grids they noted (at times with irritation) that the tool challenged their usual way of behaving and communicating. However they reported that they had grown in confidence and had learnt to personalize the grid to the patient’s needs. The clinicians also described that the tool, by providing a clear comparison frame, had enabled their approach to be more neutral and acted as a reminder to share accurate data about the probability of harms.

Consequences

The clinicians, although initially skeptical about the value of Option Grids, became more confident that the Option Grid was acceptable to patients and were therefore willing to explore how best to use them in their clinical encounters. How best to introduce Option Grids to clinicians, and to adopt their use into practice, will need careful consideration.

Credits

• Fiona Wood, Pennine MSK Ltd, Oldham, Greater Manchester, UK
• Julie Rasmussen, Pennine MSK Ltd, Oldham, Greater Manchester, UK
• Adrian Edwards, Pennine MSK Ltd, Oldham, Greater Manchester, UK
• Katharine Kinsey, South East Trials Unit, Cardiff University, Cardiff, Wales, UK
• Jill Firth, South East Trials Unit, Cardiff University, Cardiff, Wales, UK
• Alan Nye, South East Trials Unit, Cardiff University, Cardiff, Wales, UK
• Katherine Brain, Pennine MSK Ltd, Oldham, Greater Manchester, UK
• Timothy Pickles, The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire, USA
• Glyn Elwyn