'There is no need to worry': how general practitioners integrate patient concerns into the shared decision-making dialogue.

Objectives Many models, measures and theories on shared decision-making (SDM) stress the importance of addressing patient concerns. Yet, limited research is available on how concerns are integrated in and shape the SDM dialogue between patients and clinicians. This study provides insights into how the SDM dialogue unfolds when patients express concerns. Methods Data consisted of 181 video-recorded Dutch GP-patient encounters. The VR-CoDES was used to identify patient concerns and as an inspiration to categorize GP strategies for integrating concerns in the SDM dialogue. The OPTION 5 was used to identify the SDM dialogue and calculate the extent to which GPs applied SDM. A two-tailed t-test was used to test differences in SDM application in encounters with versus without concerns. Results Patients expressed concerns about their health complaint and about treatment. The former was often combined with or formulated as a treatment request and the latter as rejection of a certain treatment. GPs addressed and integrated both types of patient concerns into the SDM dialogue through various strategies: they provided tailored information, offered explicit reassurance, shared their professional opinion, focused on picking treatment, gave patients decisional control and they explored concerns. In several cases, patients became open to reconsider the treatment they initially requested or rejected. Seen on a 100-point scale, GPs’ SDM application was higher in encounters with (M = 36.3) versus without concerns (M = 31.1). This difference tested significant (t(18) = 2.52, p < 0.05), though with a small effect size (d = 0.23). Conclusion Clinicians used various strategies to integrate patient concerns into the SDM dialogue. Patients often expressed concerns in the form of a treatment rejection or request. Implications These findings suggest that through integrating patient concerns into the SDM dialogue, patients can become more open to (re)consider and discuss feasible treatment options.