Article Figures & Data
Figures
- Figure 1.
Study participant flow diagram
Tables
TYPE OF EXPRESSION AND EXPRESSIONS CODED EXAMPLES Risk communication • Statement about potential benefits or harms “This medication has some side effects” • Expression of probability or uncertainty “The most severe side effects are rare” • Numbers “Less than 1 in a thousand” Values clarification • Efficacy and side effects “I did not try the medication because of the side effects” • Frequency of administration “It’s really hard to make it to physiotherapy twice a week” • Mode of administration and cost “I have no insurance. For all the rest I am covered, but not for that” • Patient priorities “I really don’t want to have to miss work” • Life philosophies or identity “I am not the kind of person who wants to suffer” • Background “No one in my family has ever breastfed” • Life circumstances or context “My father-in-law is living with us so I plan meals that he likes” - Table 2.
Participant characteristics: We report the mean and SD if the distribution is normal, and median and IQR if the distribution is not normal.
CHARACTERISTIC PATIENTS (N = 238) HEALTH PROFESSIONALS (N = 71) Site, n (%) • 1 48 (20) 14 (20) • 2 50 (21) 18 (25) • 3 62 (26) 12 (17) • 4 40 (17) 12 (17) • 5 38 (16) 15 (21) Female sex, n (%) 181 (76) 48 (68) • Physicians NA 25 (52) • Residents NA 16 (33) • Nurses and dietitians NA 7 (15) Male sex, n (%) 57 (24) 23 (32) • Physicians NA 14 (61) • Residents NA 9 (39) • Nurses and dietitians NA 0 (0) Median (IQR) age 39 (16 to 82) 33 (23 to 64) • Physicians NA 40 (26 to 64) • Residents NA 27 (23 to 40) • Nurses and dietitians NA 30 (28 to 53) Level of education, n (% of 238) • Low 89 (37) NA -None or some elementary school 2 (< 1) NA -Elementary school 18 (8) NA -Secondary school diploma 42 (18) NA -Secondary school vocational diploma 27 (11) NA • Medium (ie, cégep*) 47 (20) NA • High 98 (41) NA -Bachelor degree 65 (27) NA -Master’s degree 24 (10) NA -Doctoral or professional degree 9 (4) NA • Missing data 4 (2) NA Median (IQR) health literacy score† 13 (3 to 18) NA Subjective Numeracy Scale score‡ 36 (8 to 48) 39 (4) Health professionals, n (%) • Physicians NA 39 (55) • Residents NA 25 (35) • Nurses and dietitians NA 7 (10) Place of origin, n (%) • Quebec 194 (82) 59 (83) • Other Canadian province 8 (3) 4 (6) • Other country 34 (14) 8 (11) • Missing data 2 (< 1) 0 (0) Median (IQR) years in Quebec 33 (1 to 79) 32 (1 to 75) Median (IQR) years in practice • Overall NA 5 (1 to 40) • Physicians NA 12 (1 to 40) • Residents NA 1.5 (1 to 8) • Nurses and dietitians NA 6.5 (1 to 32) Median (IQR) years in clinic NA 3 (1 to 26) Control Preferences Scale score,§ n (%) • 1 13 (5) 7 (10) • 2 122 (51) 19 (27) • 3 69 (29) 39 (55) • 4 27 (11) 2 (3) • 5 4 (2) 0 (0) • Missing data 3 (1) 4 (6) Languages spoken,‖ n (%) • French 231 (97) 71 (100) • English 212 (89) 70 (99) Visible minorities,¶ n (%) 30 (13) 4 (6) People with disabilities,# n (%) 10 (4) 0 (0) IQR—interquartile range, NA—not applicable.
↵* Cégep is a stage of education in Quebec. It typically requires 2 years of study after grade 11. Graduates might then go on to college or university.
↵† Health literacy is defined as the capacity to understand basic health information.
↵‡ This scale rates confidence in working with numbers and preferences for numerical information. Scores are reported as median (IQR) for patients and as mean (SD) for health professionals.
↵§ The Control Preference Scale rates preferences as follows: 1 = prefers that the patient makes the final decision alone, 2 = prefers that the patient makes the decision after seriously considering the health professional’s opinion, 3 = prefers that the patient and the health professional share responsibility for the decision, 4 = prefers that the health professional makes the decision after he or she seriously considers the patient’s opinion, and 5 = prefers that the health professional makes the decision alone.
↵‖ Not mutually exclusive.
↵¶ Visible minorities are defined as “persons, other than aboriginal peoples, who are non-Caucasian in race or non-white in color.”41
↵# Disability is defined as physical, cognitive, intellectual, mental, sensory, or developmental impairment.
- Table 3.
Frequencies of risk communication and values clarification in primary care visits: N = 238. We analyzed both objectives with GLMM to account for the potential clustering effect of health professionals, but assumed observations within each clinic to be similar owing to the low ICC at the clinic level.
VISITS IN WHICH DECISIONS WERE MADE ABSENCE OF RISK COMMUNICATION, N (%) PRESENCE OF RISK COMMUNICATION, N (%) TOTAL, N (%) Absence of values clarification 23 (10) 53 (22) 76 (32) Presence of values clarification 12 (5) 150 (63)* 162 (68)† Total 35 (15) 203 (85)‡ 238 (100) GLMM—generalized linear mixed model, ICC—intraclass correlation coefficient.
↵* The ICCs for risk communication and values clarification together were 0.15 at the level of health professionals and 0.0001 at the clinic level.
↵† The ICCs for values clarification alone were 0.07 at the level of health professionals and 0.0001 at the clinic level.
↵‡ The ICCs for risk communication alone were 0.43 at the level of health professionals and 0.05 at the clinic level.
- Table 4.
Visit characteristics: N = 238. Median (IQR) visit length in minutes was 29.2 (5.2 to 97.3).
CHARACTERISTIC N (%) No. of decisions per visit* • 1–2 88 (37) • 3–4 81 (34) • 5–10 69 (29) Reason for visit • Checkup or regular preventive care 163 (69) • Medical reasons 75 (32) -1 49 (65) -Several 26 (35) Visit included ≥ 1 decisions to ...† • Begin something 187 (79) • Continue something 174 (73) • Do nothing 45 (19) • Postpone the decision 41 (17) • Take action later‡ 23 (10) • Stop something 21 (9) Visit included ≥ 1 decisions about ...† • Treatment options (medical or surgical) 169 (71) • Screening tests 93 (39) • Diagnostic tests 87 (37) • Follow-up of tests or treatment given or prescribed 87 (37) • Following and watching something 69 (29) • Treatment plan (discussion of lifestyle changes) 49 (21) • Referral to another specialist 36 (15) • Referral to an allied health professional 31 (13) Patient knows health professional • Yes, the patient recalled having seen this professional before 179 (75) • No, the patient did not recall having seen this professional before 59 (25) Risk communication • No 35 (15) • Yes 203 (85) -Yes, in words without numbers 165 (81) -Yes, in numbers 38 (19) —Numbers were probabilities 23 (61) —Other type of numbers 15 (39) Values clarification • No 76 (32) • Yes 162 (68) -Yes, clinician asks a question 97 (60) -Yes, clinician makes a statement that invites a response 1 (1) -Yes, patient initiates the discussion 64 (40) IQR—interquartile range.
↵* Categories reflect distribution within our study and clinician team members’ assessments of meaningful differences.
↵† These categories are not mutually exclusive.
↵‡ A decision was made to take action at a subsequent visit (eg, a decision to have a Papanicolaou test at the next visit).
- Table 5.
Factors associated with risk communication and values clarification (multivariable analysis)
FACTOR* BOTH RISK COMMUNICATION AND VALUES CLARIFICATION PRESENT 1 OR BOTH OF RISK COMMUNICATION AND VALUES CLARIFICATION MISSING OR (95% CI) P VALUE Factors associated with the visit No. of decisions per visit, n (%) • 1–2 34 (39) 54 (61) 1 • 3–4 54 (67) 27 (33) 1.40 (0.59 to 3.16) • ≥ 5 62 (90) 7 (10) 5.00 (1.50 to 16.90) .03 Median (IQR) length of visit, min 30.3 (9.8 to 97.3) 25.8 (5.2 to 58.5) 1.03 (1.00 to 1.07) .03 Decisions to postpone the decision,† n (%) • No 115 (58) 82 (42) 1 • Yes 35 (85) 6 (15) 4.92 (1.35 to 17.87) .02 Decisions to begin something,† n (%) • No 19 (37) 32 (63) 1 • Yes 131 (70) 56 (30) 3.54 (1.32 to 9.48) .01 Decisions about referral to an allied health professional,† n (%) • No 124 (60) 83 (40) 1 • Yes 26 (84) 5 (16) 5.09 (0.96 to 27.04) .06 Decisions about treatment,† n (%) • No 24 (35) 45 (65) 1 • Yes 126 (75) 43 (25) 3.56 (1.52 to 8.36) .004 Factors associated with health professionals Control Preferences Scale score,‡ n (%) • No collaboration 1 (14) 6 (86) 1 • Collaboration 36 (60) 24 (40) 8.78 (1.62 to 47.71) .01 IQR—interquartile range, OR—odds ratio.
↵* Factors for analysis selected based on bivariate analysis.
↵† Not mutually exclusive.
↵‡ No collaboration includes the 2 extreme items on the scale (ie, “prefers that the patient makes the final decision alone” and “prefers that the health professional makes the decision alone”). Collaboration includes the 3 middle items on the scale (ie, “prefers that the patient makes the decision after seriously considering the health professional’s opinion,” “prefers that the patient and the health professional share responsibility for the decision,” and “prefers that the health professional makes the decision after he or she seriously considers the patient’s opinion”).
