Associations between physicians' SDM behaviour and participation of older patients and family members in triadic decision-making: An observational study

Background

Medical consultations with older patients often include triadic conversations and decision-making processes involving physicians, patients, and family members. The presence of family members may change the communication dynamics and therefore increase the complexity of the consultation and decision-making process.

Objective

This study explored associations between physicians' shared decision-making (SDM) behaviour and patients' and family members' participation in the decision-making process.

Methods

Using an observational design, we analysed 95 recorded consultations between medical specialists, patients aged ≥65 years, and accompanying family members at a Dutch hospital. The OPTION^MCC was used to assess the physicians' SDM behaviour and patients' and family members' levels of involvement in SDM.

Results

We found a strong positive correlation between physicians' behaviour and patients' and family members' participation in SDM (0.68 and 0.64, respectively, p < .01). Family members were more involved in SDM for patients aged 80 and older.

Conclusion

While not asserting causation, our study suggests physicians potentially play a facilitating role in shaping the SDM process together with proactive contributions from patients and family members.

Innovation

The results offer new insights into triadic SDM and provide suggestions for refining the OPTION^MCC. Further research is recommended into participants' mutual directional influences in triadic SDM.