Training family physicians in shared decision-making to reduce the overuse of antibiotics in acute respiratory infections: a cluster randomized trial
Open accessAbstract
BACKGROUND: Few interventions have proven effective in reducing the overuse of antibiotics for acute respiratory infections. We evaluated the effect of DECISION+2, a shared decision-making training program, on the percentage of patients who decided to take antibiotics after consultation with a physician or resident. METHODS: We performed a randomized trial, clustered at the level of family practice teaching unit, with 2 study arms: DECISION+2 and control. The DECISION+2 training program included a 2-hour online tutorial followed by a 2-hour interactive seminar about shared decision-making. The primary outcome was the proportion of patients who decided to use antibiotics immediately after consultation. We also recorded patients' perception that shared decision-making had occurred. Two weeks after the initial consultation, we assessed patients' adherence to the decision, repeat consultation, decisional regret and quality of life. RESULTS: We compared outcomes among 181 patients who consulted 77 physicians in 5 family practice teaching units in the DECISION+2 group, and 178 patients who consulted 72 physicians in 4 family practice teaching units in the control group. The percentage of patients who decided to use antibiotics after consultation was 52.2% in the control group and 27.2% in the DECISION+2 group (absolute difference 25.0%, adjusted relative risk 0.48, 95% confidence interval 0.34-0.68). DECISION+2 was associated with patients taking a more active role in decision-making (Z = 3.9, p < 0.001). Patient outcomes 2 weeks after consultation were similar in both groups. INTERPRETATION: The shared decision-making program DECISION+2 enhanced patient participation in decision-making and led to fewer patients deciding to use antibiotics for acute respiratory infections. This reduction did not have a negative effect on patient outcomes 2 weeks after consultation. ClinicalTrials.gov trial register no. NCT01116076.
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Decision aids are effective tools for promoting shared decision making.
“Decision aids (DAs) are effective tools for promoting SDM [9], and could also be used to support IP-SDM.”
From Development of a decision guide to support the elderly in decision making about location of care: an iterative, user-centered design (2016) · cites this paper as [9]
The Randomization section says DECISION+2 included decision aids, and the Abstract reports greater patient participation in decision-making. But the Interpretation section says the trial could not identify which components were effective, so it does not establish that decision aids themselves promoted shared decision-making. (LLM, conf=0.87)
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Self-citation
- Authors
- Légaré, F., Labrecque, M., Cauchon, M., Castel, J., Turcotte, S., & Grimshaw, J.
- Affiliations
- Centre hospitalier universitaire de Québec (CA)
- Venue
- Canadian Medical Association Journal
- Publisher
- CMA Joule Inc.
- Published
- 2012-07-30
- Volume
- 184
- Issue
- 13
- Pages
- E726-E734
- ISSN
- 0820-3946 (ISSN-L)
- 1488-2329
- PMC
- PMC3447039
- OpenAlex
- W2096625895
- Cited by
- 220
- References
- 33
- Citations by year
- 2026: 2 · 2025: 9 · 2024: 17 · 2023: 8 · 2022: 18 · 2021: 14 · 2020: 31 · 2019: 21 · 2018: 18 · 2017: 16 · 2016: 14 · 2015: 19 · 2014: 14 · 2013: 17 · 2012: 1
- FWCI
- 17.83
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Canadian Medical Association Journal (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Université Laval
- Topics
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Keywords
- shared decision-making, antibiotic overuse, acute respiratory infections, general practitioners, physician training, patient involvement in treatment decisions, quality of life
- MeSH terms
- Acute Disease, Adult, Anti-Bacterial Agents, Child, Preschool, Communication, Decision Making, Female, Humans, Male, Patient Compliance, Physician-Patient Relations, Physicians, Family, Respiratory Tract Infections
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