Shared decision making in Australian physiotherapy practice: A survey of knowledge, attitudes, and self-reported use

Objective To assess Australian physiotherapists’ knowledge about, attitudes towards, and self-reported use of shared decision making, as well as perceived barriers to its implementation in practice. Methods Physiotherapists registered for a national Australian physiotherapy conference were invited via email and the conference app to complete a self-administered online questionnaire about shared decision making, including: a) knowledge, b) attitude to and reported approach in practice, c) behaviours used, d) barriers, e) previous training and future training interest. Responses were analysed descriptively and open-ended questions synthesised narratively. Results 372 physiotherapists (71% female, mean age 45 years, mean experience 23 years) completed the survey. Respondents had a good level of knowledge on most questions, with correct responses ranging from 39.5% to 98.5% of participants, and a generally positive attitude towards shared decision making, believing it useful to most practice areas. Sixty percent indicated they make decisions with their patients and there was general agreement between how decisions should be made and how they are actually made. The behaviour with the lowest reported occurrence was explaining the relevant research evidence about the benefits and harms of the options. The main perceived barriers were patient knowledge and confidence, consequent fewer physiotherapy sessions, and time constraints. Most (79%) were keen to learn more about shared decision making. Conclusions Shared decision making is of growing importance to all health professions and rarely studied in physical therapy. This sample of Australian physiotherapists had a generally positive attitude to shared decision making and learning more about it. Opportunities for providing such skills training at the undergraduate level and in continuing professional development should be explored. This training should ensure that the communicating evidence component of shared decision making is addressed as well as debunking myths about perceived barriers to its implementation.


How much do you know about the concept of shared decision making
❑ The patient makes the treatment decision on her/his own. ❑ Not applicable -I do not work clinically.

These questions relate to shared decision making. Please indicate whether you feel each of the following statements is TRUE or FALSE. **
Shared decision making causes patients to feel uncertain about their decisions. ☐ True ☐ False Doing shared decision making will increase the length of a visit/consultation.** ☐ True ☐ False Most patients will understand natural frequency (e.g., 1 in every 100 people) better than a percentage (e.g 10% of people).
☐ True ☐ False Understanding the mechanism or pathophysiology of how a treatment works is more important than having evidence about the treatment's effect.** ☐ True ☐ False There is not enough evidence about the effectiveness of some physiotherapy treatments. This makes talking with patients about treatment options and the advantages and disadvantages of the options difficult.**

☐ True ☐ False
When communicating information about risks, it is best to use relative risk (e.g. double the risk of an adverse event occurring from a treatment).
☐ True ☐ False To promote shared decision making, a clinician will support the patient in becoming informed and comparing options. ☐ True ☐ False To promote shared decision making, a physiotherapist should indicate that alternative treatment or management options exist (including that one option may be 'no action').

☐ True ☐ False
By doing shared decision making, patients will be more likely to adhere to the chosen treatment plan.** ☐ True ☐ False Whenever possible, I should try to explain the natural history of a condition to patients and what might happen without active treatment.** ☐ True ☐ False Access to decision support tools that summarise the evidence-based benefits and harms of treatment options for different conditions/problems would be helpful.
☐ True ☐ False 9. Have you worked clinically within the last 2 years?

❑ Yes ❑ No
If answered yes to question 9, proceed to question 10 10. Please think of the last treatment session in which a treatment decision was made.

What health complaint/problem/illness was the treatment session about?
What treatment was decided upon? * 11. Some statements related to the decision making in the above consultation are listed below. For each statement, please indicate how much you agree or disagree. †  14. Please read the following scenario and then indicate which decision style you would use if you were in this situation. There are no right or wrong answers. † A 35 year old female presents to your practice with symptoms of tennis elbow/lateral epicondylalgia. She is unsure of whether she should undertake physiotherapy treatment, an oral non-steroidal anti-inflammatory drug she has read about online, or a steroid injection that her colleague had when they had tennis elbow. You conduct a clinical assessment.Imagine that you are the therapist in this situation, how would you respond? (choose one response) ❑ I would use evidence-based information to decide on the best course of action for the patient and inform the patient of my decision.
❑ I would share evidence-based information with the patient, and elicit his/her preference so that we make an informed decision together.
❑ I would share evidence-based information with the patient and allow him/her to make the decision on their own.