Background. Shared decision making (SDM) and patient self-management support are key components of US and UK policy for chronic disease management, whereby SDM is seen as enhancing physician-patient negotiation around self-management. The WISE trial is implementing training in self-management support for primary care physicians in one UK region. This article describes preintervention levels of patient-reported SDM and explores how this varies with patient and practice characteristics. Methods. We analyzed baseline data from a cluster randomized controlled trial for 2965 patients with diabetes, chronic obstructive pulmonary disease, and irritable bowel syndrome (IBS) from 29 family practices. Patient-level measures included self-report of chronic conditions, SDM (Health Care Climate Questionnaire [HCCQ]), health status, and demographic characteristics. Area and practice characteristics included chronic disease workload and socioeconomic deprivation. Results. The mean SDM score was 75 (out of 100), but the range was wide. The mean score was lower for IBS patients but did not vary with other disease conditions. Younger patients and those with poorer health status reported lower degrees of SDM. No associations were found with practice characteristics. Limitations. The study was restricted to one socioeconomically deprived region, and hence results may not be nationally representative of the United Kingdom. Ceiling effects on SDM scores may limit the utility of the HCCQ. Conclusions. Lower ratings from some patient groups may reflect differences in expectations rather than differences in physician behavior. Overall levels of SDM were high, and no patient or practice characteristic represented a serious barrier to SDM. However, we cannot say to what extent SDM in this chronic population addressed self-management issues rather than clinical care. More nuanced measures of SDM are required that distinguish between different forms of care.
WagnerEHAustinBTDavisCHindmarshMSchaeferJBonomiA. Improving chronic illness care: translating evidence into action. Health Affairs. 2001;20:64–78.
2.
BodenheimerTWagnerEHGrumbachK. Improving primary care for patients with chronic illness: the chronic care model, part 2. JAMA. 2002;288:1909–14.
3.
LégaréFRattéSStaceyD., et al. Interventions for improving the adoption of shared decision making by healthcare professionals. Cochrane Database Syst Rev. 2010;(5):CD006732.
4.
MichieSMilesJWeinmanJ. Patient-centredness in chronic illness: what is it and does it matter?Pat Educ Couns. 2003;51:197–206.
5.
WilliamsGFreedmanZDeciE. Supporting autonomy to motivate patients with diabetes for glucose control. Diabetes Care. 1998;21:1644–51.
6.
MeadNBowerP. Patient-centredness: a conceptual framework and review of the empirical literature. Soc Sci Med. 2000;51:1087–110.
7.
HeislerMTierneyEAckermannRT. Physicians’ participatory decision-making and quality of diabetes care processes and outcomes: results from the triad study. Chronic Illness. 2009;5:165–76.
8.
BaldwinASCvengrosJAChristensenAJIshaniAKaboliPJ. Preferences for a patient-centered role orientation: association with patient-information-seeking behavior and clinical markers of health. Ann Behav Med. 2008;35:80–6.
9.
HeislerMBouknightRRHaywardRASmithDMKerrEA. The relative importance of physician communication, participatory decision making, and patient understanding in diabetes self-management. J Gen Intern Med. 2002;17:243–52.
10.
HolmanHLorigK. Patients as partners in managing chronic disease. BMJ. 2000;320:527–8.
11.
HurkmansEJMaesSDe GuchtV., et al. Motivation as a determinant of physical activity in patients with rheumatoid arthritis. Arthritis Care Res. 2010;62:371–7.
12.
WilliamsGCGrowVMFreedmanZRRyanRMDeciEL. Motivational predicators of weight loss and weight-loss maintenance. J Pers Soc Psychol. 1996;70:115–26.
13.
WilliamsGCFreedmanZRDeciEL. Supporting autonomy to motivate patients with diabetes for glucose control. Diabetes Care. 1998;21:1644–51.
14.
LohALeonhartRWillsCESimonDHarterM. The impact of patient participation on adherence and clinical outcome in primary care of depression. Patient Educ Counsel. 2007;65:69–78.
15.
FroschDLMoultonBWWexlerRM. Shared decision making in the United States: policy and implementation activity on multiple fronts. Z Evid Fortbild Qual Gesundhwes. 2011;105:305–12.
16.
EpperlyT. The patient-centred medical home in the USA. J Eval Clin Pract. 2011;17:373–5.
17.
Robert Graham Centre. The Patient Centered Medical Home: History, Seven Core Features, Evidence and Transformational Change. Washington, DC: Robert Graham Centre; 2007. Available from: http://www.graham-center.org/PreBuilt/PCMH.pdf. Accessed 14 May 2012.
Department of Health. Self Care—A Real Choice: Self Care Support—A Practical Option. London, England: Department of Health; 2005.
20.
KennedyARogersABowerP. Support for self care for patients with chronic disease. BMJ. 2007;335:968–70.
21.
KennedyAChew-GrahamCBlakemanT., et al. Delivering the WISE (Whole Systems Informing Self-Management Engagement) training package in primary care: learning from formative evaluation. Implementation Sci. 2010;5:7. Available from:http://www.implementationscience.com/content/5/1/7. Accessed 14 May 2012.
22.
BowerPKennedyAReevesD., et al. A cluster randomised controlled trial of the clinical and cost-effectiveness of a ‘whole systems’ model of self-management support for the management of long-term conditions in primary care: trial protocol. Implementation Sci. 2012;26(7):7. Available from: http://www.implementationscience.com/content/7/1/7. Accessed 12 May 2012.
23.
RobinsonALeeVKennedyA., et al. A randomised controlled trial of self-help interventions in patients with a primary care diagnosis of irritable bowel syndrome. Gut. 2006;55:643–8.
24.
DeakinTMcShaneCCadeJWilliamsR. Group based training for self-management strategies in people with type 2 diabetes mellitus. Cochrane Database Syst Rev. 2005;(2):CD003417.
25.
EffingTMonninkhofEvan der ValkP., et al. Self management education for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2007;(4):CD002990.
26.
BMANE. Quality and Outcomes Framework Guidance for GMS Contract 2009/10: Delivering Investment in General Practice. London: BMA NE;2009.
27.
WilliamsGCMcGregorHAKingDNelsonCCGlasgowRE. Variation in perceived competence, glycemic control, and patient satisfaction: relationship to autonomy support from physicians. Patient Educ Counsel. 2005;57:39–45.
28.
WilliamsGCMcGregorHAZeldmanAFreedmanZRDeciEL. Testing a self-determination theory process model for promoting glycemic control through diabetes self-management. Health Psychol. 2004;23:58–66.
29.
KindP. The EuroQoL instrument: an index of health-related quality of life. In: SpilkerB, ed. Quality of Life and Pharmacoeconomics in Clinical Trials. Philadelphia, PA: Lippincott-Raven; 1996.
30.
LorigKStewartARitterPGonzálezVLaurentDLynchJ. Outcome Measures for Health Education and Other Health Care Interventions. Thousand Oaks, CA: Sage; 1996.
O’BrienRM. A caution regarding rules of thumb for variance inflation factors. Quality Quantity. 2007;41:673–90.
33.
KontopantelisERolandRReevesD. Patient experience of access to primary care: identification of predictors in a national patient survey. BMC Family Pract. 2010;11:61. Available from: http://www.biomedcentral.com/1471-2296/11/61. Accessed 12 May 2012.
34.
MeadNBowerPRolandM. The General Practice Assessment Questionnaire (GPAQ): development and psychometric characteristics. BMC Family Pract. 2008;9:13. Available from: http://www.biomedcentral.com/1471–2296/9/13. Accessed 14 May 2012.
35.
CrowRGageHHampsonS. The measurement of satisfaction with healthcare: implications for practice from a systematic review of the literature. Health Technol Assess. 2002;32:1–235.
36.
SalisburyCWallaceMMontgomeryAA. Patients’ experience and satisfaction in primary care: secondary analysis using multilevel modelling. BMJ. 2010;341:c5004.
37.
LyratzopoulosGElliotMBarbiereJM., et al. Understanding ethnic and other socio-demographic differences in patient experience of primary care: evidence from the English general practice patient survey. BMJ Qual Saf2010;21:21–9.
CleverSLFordDERubensteinLV., et al. Primary care patients’ involvement in decision-making is associated with improvement in depression. Med Care. 2006;44:398–405.
40.
DaveyHMBarrattALDaveyE., et al. Medical tests: women’s reported and preferred decision-making roles and preferences for information on benefits, side-effects and false results. Health Expect. 2002;5:330–40.
41.
GotlerRGFlockeSAGoodwinMAZyzanskiSJMurrayTHStangeKC. Facilitating participatory decision-making: what happens in real-world community practice?Med Care. 2000;38:1200–9.
42.
CegalaDJ. An exploration of factors promoting patient participation in primary care medical interviews. Health Commun. 2011;26:427–36.
43.
StreetRlGordonHSWardMMKrupatEKravitzRL. Patient participation in medical consultations: why some patients are more involved than others. Med Care. 2005;10:960–9.
44.
WensingMElwynGEdwardsAVingerhoetsEGrolR. Deconstructing patient centred communication and uncovering shared decision making: an observational study. BMC Medical Inform Decis Making. 2002;2:2.
45.
RogersALeeVKennedyA. Continuity and change? Exploring reactions to a guided self-management intervention in a randomised controlled trial for IBS with reference to prior experience of managing a long-term condition. Trials. 2007;8:6.
46.
BlakemanTBowerPReevesDChew-GrahamC. Bringing self-management into clinical view: a qualitative study of long-term condition management in primary care consultations. Chronic Illness. 2010;6:136–50.
47.
RiegelBMoserDKAnkerSD., et al. State of the science: promoting self-care in persons with heart failure: a scientific statement from the American Heart Association. Circulation. 2009;120:1141–63.
