More doctors are engaging in shared decision-making with their patients.
What hasn’t been studied is the best time for the physician to provide their recommendation on a particular course of treatment. Researchers in Germany delved into that very question in a study recently published in The BMJ.
Their finding? At whatever point in time a physician gives advice, that opinion has an influence on a patient's decision. Previous studies suggested doctors should refrain from providing a recommendation to patients in the early stage of their illness. Instead, they said physicians should provide their recommended treatment options to patients only after patients have made their own determinations about the appropriate treatment path so as not to adversely influence patient preferences, say researchers. But in this study, even physicians who made recommendations late in the process, were able to change patients' minds about their preferences.
In all, 208 patients diagnosed with schizophrenia--whose average age was 40--agreed to take part in the study and provided full data. Based on a hypothetical scenario, they were given the choice of two drug treatments that had similar outcomes--albeit with different side effects, such as dry mouth or tiredness.
Researchers discovered that 49 of the patients who received “late advice” from their physician went against their own original decision-making. In essence, a late recommendation potentially sweeps away a whole shared decision-making process in just a few seconds if the advice is contrary to the patient's preference, researchers said. Only 36 patients who received “early advice” went against their doctors’ recommendation.
Study participants included 89 women and 119 men. Participants were organized into groups where they received no advice from their doctor or they received advice at the beginning of their diagnosis or at a more advanced stage in their illness.
“Physicians must be aware that giving an advice powerfully inﬂuences their patients’ decision-making, probably in unexpected ways. In addition, patients’ reaction might be dependent from the setting and diagnosis,” the study said.