Résumé :
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[BDSP. Notice produite par INIST kAl7TR0x. Diffusion soumise à autorisation]. Context Many clinicians have called for an increased emphasis on the patient's role in clinical decision making. However, little is known about the extent to which physicians foster patient involvement in decision making, particularly in routine office practice. Objective To characterize the nature and completeness of informed decision making in routine office visits of both primary care physicians and surgeons. Design Cross-sectional descriptive evaluation of audiotaped office visits during 1993. Setting and Participants A total of 1057 encounters among 59 primary care physicians (general internists and family practitioners) and 65 general and orthopedic surgeons ; 2 to 12 patients were recruited from each physician's community-based private office. Main Outcome Measures Analysis of audiotaped patient-physician discussions for elements of informed decision making, using criteria that varied with the level of decision complexity : basic (eg, laboratory test), intermediate (eg, new medication), or complex (eg, procedure). Criteria for basic decisions included discussion of the nature of the decision and asking the patient to voice a preference ; other categories had criteria that were progressively more stringent. Results The 1057 audiotaped encounters contained 3552 clinical decisions. Overall, 9.0% of decisions met our definition of completeness for informed decision making. (...)
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