Shared decision making about blood tests: secondary analysis of video-recorded primary care consultations

Research output: Contribution to journalArticle (Academic Journal)

Abstract

Background
Awareness about the importance of shared decision-making (SDM) is widespread, however little research has focused on discussions surrounding investigations, despite increasing laboratory testing in primary care.

Aim
To explore the discussion of blood tests in routine primary care consultations.

Design and Setting
Secondary analysis of a sample of 50 video-recorded routine primary care consultations from 22 GPs across 12 practices, plus linked survey and records data, from the One in a Million archive.

Method
A coding scheme was developed using qualitative content analysis to explore discussion of blood tests in transcripts of recorded consultations. Codes focused on instigating testing, the extent of SDM, and how results were explained. Survey data were used to compare patients’ pre-visit expectations with consultation content. Medical records were reviewed to compare tests discussed with those ordered.

Results
In 36/50 consultations which discussed ordering blood tests, 31% of patients hinted they wanted a blood test, however none explicitly asked. Only 11% were offered alternative options. In 81% of cases the GP gave some explanation of the indication, but only 17% explained limitations of testing. Only 32% of patients were informed about all blood tests ordered. Of 23/50 consultations in which results were conveyed, the GP gave no explanation of the results in 26% of cases. 57% of patients were only informed of an 'assessment' (e.g. ‘normal’), rather than the actual result.

Conclusion
A lack of information-giving and SDM exists surrounding ordering tests and conveying results. Promoting SDM could reduce unnecessary testing and improve patient-centred care.
Original languageEnglish
Article numberbjgp20X709409
JournalBritish Journal of General Practice
Early online date20 Apr 2020
DOIs
Publication statusE-pub ahead of print - 20 Apr 2020

Keywords

  • general practice
  • qualitative research
  • decision making

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