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Henry N. Young, PhD; Robert A. Bell, PhD; Ronald M. Epstein, MD; Mitchell D. Feldman, MD, MPhil; Richard L. Kravitz, MD, MSPH

Arch Intern Med. 2008;168(13):1404-1408.

Background  Although shared decision making (SDM) has been reported to facilitate quality care, few studies have explored the extent to which SDM is implemented in primary care and factors that influence its application. This study assesses the extent to which physicians enact SDM behaviors and describes factors associated with physicians' SDM behaviors within the context of depression care.

Methods  In a secondary analysis of data from a randomized experiment, we coded 287 audiorecorded interactions between physicians and standardized patients (SPs) using the Observing Patient Involvement (OPTION) system to assess physician SDM behaviors. We performed a series of generalized linear mixed model analyses to examine physician and patient characteristics associated with SDM behavior.

Results  The mean (SD) OPTION score was 11.4 (3.3) of 48 possible points. Older physicians (partial correlation coefficient = –0.29; β = –0.09; P < .01) and physicians who practiced in a health maintenance organization setting (β = –1.60; P < .01) performed fewer SDM behaviors. Longer visit duration was associated with more SDM behaviors (partial correlation coefficient = 0.31; β = 0.08; P < .01). In addition, physicians enacted more SDM behaviors with SPs who made general (β = 2.46; P < .01) and brand-specific (β = 2.21; P < .01) medication requests compared with those who made no request.

Conclusions  In the context of new visits for depressive symptoms, primary care physicians performed few SDM behaviors. However, physician SDM behaviors are influenced by practice setting and patient-initiated requests for medication. Additional research is needed to identify interventions that encourage SDM when indicated.

Author Affiliations: Social and Administrative Sciences Division, School of Pharmacy, University of Wisconsin–Madison, Madison (Dr Young); Center for Healthcare Policy and Research (Drs Bell and Kravitz) and Departments of Communication and Public Health Sciences (Dr Bell) and Internal Medicine (Dr Kravitz), University of California, Davis; Departments of Family Medicine and Psychiatry and Center to Improve Communication in Health Care, University of Rochester School of Medicine and Dentistry, Rochester, New York (Dr Epstein); and Division of General Internal Medicine, Department of Medicine, University of California, San Francisco (Dr Feldman).

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