Work

Getting to what matters for people with osteoporosis in clinical consultations with and without conversation aids: A videographic analysis

Year: 2025

Type: article

Abstract: OBJECTIVE: To evaluate if, and how, clinicians elicit and address health and medicine beliefs in osteoporosis consultations, and to evaluate the impact of a conversation aid (CA) on clinician behaviour. METHODS: Secondary analysis of 107 video-recorded consultations from two trials evaluating CAs, using a bespoke coding tool to record the presence or absence of clinician shared decision-making (SDM) behaviours. In addition to descriptive statistics, Fisher's exact test examined differences between consultations with and without CAs. RESULTS: Clinicians framed osteoporosis as a bone density (92 %) and/or fracture risk problem (78 % overall (96 % usual care vs 62 % aided, p < 0.001)). Biopsychosocial consequences of fractures were rarely mentioned. Clinicians asked questions to elicit beliefs in 58 % of consultations, most commonly general views on medications (47 % usual care vs 26 % aided, p = 0.03). Clinicians rarely asked about beliefs related to osteoporosis (n = 3), perceived need for (n = 1), concerns about (n = 5), or practical issues (n = 6) with medication. Clinicians used persuasion techniques more commonly in aided consultations (88 % vs 64 %, p = <0.001). Patient understanding was infrequently checked (12 %). CONCLUSIONS: Clinicians miss opportunities to support patients to get the best from osteoporosis medications by tailoring communications to address necessity, beliefs, concerns and practicalities. PRACTICE IMPLICATIONS: We need better methods for supporting clinicians in eliciting patient beliefs about osteoporosis and the medications recommended to treat it, including their need, safety, and practical issues.

Source: Patient Education and Counseling

DOI: 10.1016/j.pec.2025.109171