BMC Med Inform Decis Mak - Genders of patients and clinicians and their effect on shared decision making: a participant-level meta-analysis.

Tópicos

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Resumo

CKGROUND: Gender differences in communication styles between clinicians and patients have been postulated to impact patient care, but the extent to which the gender dyad structure impacts outcomes in shared decision making remains unclear.METHODS: Participant-level meta-analysis of 775 clinical encounters within 7 randomized trials where decision aids, shared decision making tools, were used at the point of care. Outcomes analysed include decisional conflict scale scores, satisfaction with the clinical encounter, concordance between stated decision and action taken, and degree of patient engagement by the clinician using the OPTION scale. An estimated minimal important difference was used to determine if nonsignificant results could be explained by low power.RESULTS: We did not find a statistically significant interaction between clinician/patient gender mix and arm for decisional conflict, satisfaction with the clinical encounter or patient engagement. A borderline significant interaction (p = 0.05) was observed for one outcome: concordance between stated decision and action taken, where encounters with female clinician/male patient showed increased concordance in the decision aid arm compared to control (8% more concordant encounters). All other gender dyads showed decreased concordance with decision aid use (6% fewer concordant encounters for same-gender, 16% fewer concordant encounters for male clinician/female patient).CONCLUSIONS: In this participant-level meta-analysis of 7 randomized trials, decision aids used at the point of care demonstrated comparable efficacy across gender dyads. Purported barriers to shared decision making based on gender were not detected when tested for a minimum detected difference.TRIAL REGISTRATIONS: ClinicalTrials.gov NCT00888537, NCT01077037, NCT01029288, NCT00388050, NCT00578981, NCT00949611, NCT00217061.

Resumo Limpo

ckground gender differ communic style clinician patient postul impact patient care extent gender dyad structur impact outcom share decis make remain unclearmethod participantlevel metaanalysi clinic encount within random trial decis aid share decis make tool use point care outcom analys includ decision conflict scale score satisfact clinic encount concord state decis action taken degre patient engag clinician use option scale estim minim import differ use determin nonsignific result explain low powerresult find statist signific interact clinicianpati gender mix arm decision conflict satisfact clinic encount patient engag borderlin signific interact p observ one outcom concord state decis action taken encount femal clinicianmal patient show increas concord decis aid arm compar control concord encount gender dyad show decreas concord decis aid use fewer concord encount samegend fewer concord encount male clinicianfemal patientconclus participantlevel metaanalysi random trial decis aid use point care demonstr compar efficaci across gender dyad purport barrier share decis make base gender detect test minimum detect differencetri registr clinicaltrialsgov nct nct nct nct nct nct nct

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