Jenna L Hollis, Amanda J Williams, Rachel Sutherland, Elizabeth Campbell, Nicole Nathan, Luke Wolfenden, Philip J Morgan, David R Lubans, John Wiggers
A systematic review and meta-analysis of moderate-to-vigorous physical activity levels in elementary school physical education lessons
Preventive medicine
shared decisionmaking aims combine matters patient clinician expertise develop personalized health strategy dialogue patient clinician preferences expressed misconceptions reoriented available options considered improve patient involvement would help know specific barriers facilitators patientclinician communication health literacy ability obtain process understand health information may affect patient participation decisionmaking patient quiet deferential asks questions clinician may assume paternalistic style patient greater agency engagement could catalyst shared decisions assessed 1 whether effective clinician communication effort related patient health literacy 2 factors associated effective clinician communication effort combined prospective crosssectional cohort 86 audiorecorded visits adult patients seeking specialist hand care new problem urban community hospital netherlands cohort 72 audiorecorded hand surgery visits tertiary hospital united states collected prior study american cohort represents secondary use data set patients separate study using audiorecorded visits administering similar questionnaires assessed different endpoints cohorts adult patients seeking specialist hand care new problem screened total 165 patients initially screened 96 158 participated eight percent 13 visits excluded since final diagnosis remained unclear 8 12 since first consultation current problem 5 8 one treatment option available 1 1 since language barrier total 123 patients analyzed 68 netherlands 55 united states newest vital sign nvs health literacy test validated english dutch measures ability use health information based nutrition label ice cream container used assess patient health literacy scale ranging 0 low 6 high 5item observing patient involvement option5 instrument commonly used assess quality patientclinician discussion options scores may influenced clinician effort involve patients decisionmaking well patient engagement agency item scored 0 effort 4 maximum effort total maximum score 20 two independent raters reached agreement kappa value 08 strong agreement recordings scored one investigator visit duration patient questions assessed using audio recordings patients median interquartile range age 54 38 66 years 50 men 89 white 66 nontraumatic diagnosis median irq years education 16 12 18 years median iqr health literacy score 5 2 6 median iqr visit duration 9 7 12 minutes cohorts differ important ways number visits per clinician ranged 14 29 mean overall communication effectiveness effort score visits low 85 42 points 20 points multivariate linear regression model used assess factors associated communication effectiveness effort correlation health literacy clinician communication effectiveness effort r 0087 95 ci 009 026 p 034 difference means sd categorizing health literacy inadequate 78 38 points adequate 89 45 points mean difference 10 95 ci 26 054 p 020 controlling potential confounding variables gender patient questions health literacy found longer visit duration per 1 minute increase r2 031 95 ci 014 048 p 0001 clinician 3 compared clinician 1 33 95 ci 48 229 p 0001 clinician 5 compared clinician 1 11 95 ci 15 80 p 002 independently associated effective communication effort whereas clinician 6 associated less effective communication effort compared clinician 1 008 95 ci 001 075 p 003 clinicians communication strategies clinician variable accounted 29 variation communication effectiveness effort longer visit duration accounted 11 full model accounted 47 variation p 0001 finding overall low mean communication effectiveness effort differed clinicians influenced patient factors including health literacy suggests clinicians may benefit training moves away teaching lecturing style patients receive rote directives regarding health clinicians learn adapt communication specific patient values needs using guiding rather directing communication style motivational interviewinglevel evidence level ii prognostic study