LAUSR

In shared decision-making conversations, patients with or at risk of osteoporosis and their clinicians collaborate to decide which drug treatments fit best for each person. The Perceptions and Practicalities Approach (PAPA) specifies three core considerations of drug uptake and commitment: 1) patient’s perceived personal need for treatment (necessity beliefs). 2) patient concerns about the potential adverse consequences of drugs (e.g. side effects). 3) practical difficulties (e.g. limitations in capacity and resources). This study aims to explore how discussions about perceptions and practicalities of osteoporosis drug treatment arise and evolve in the context of clinical consultations about osteoporosis. Secondary analysis of 38 video-recorded primary care consultations from a Mayo Clinic trial evaluating the Osteoporosis Choice Decision Aid. Video-recorded consultations included ‘usual care’ (n = 24) and decision aid (n = 14). Patient participants were aged 50 and over with osteopenia or osteoporosis not already receiving drug treatment. A quantitative coding scheme, informed by the PAPA, was developed to extract: i) how clinicians framed the ‘problem’ of osteoporosis, including: bone density results, fracture risk, physical impact, social impact, or psychological impact of fracture. ii) whether clinicians asked about the patients’ views of osteoporosis, patients own bone health, and the necessity, concerns, or practical issues associated with osteoporosis drugs. iii) whether clinicians personalised discussions about osteoporosis drugs to patients perceived: importance or need, side effects or harms, or practical issues. Two independent study team members dual extracted data, with a third member resolving discrepancies. Extracted data was summarised using descriptive statistics. Commonly, clinicians framed osteoporosis using the patient’s bone density results (n = 38,100%) and fracture risk (n = 30,79%). In contrast, few clinicians acknowledged the potential physical impacts of fracture (n = 5,13%), with no clinicians discussing the possible psychological or social impacts. Clinicians asked 24 questions to elicit patient views in 16 of the 38 encounters (42%, range 0-4 questions per consult). The 24 questions concerned patient views about osteoporosis (n = 1,4%), their bone health (n = 5,21%), or the necessity (n = 1,4%), concerns (n = 2,8%), or practical issues associated with osteoporosis drugs (n = 2,8%). Importantly, 14 consultations (37%) contained no questions to elicit patient views. Across the 38 consultations, clinicians personalised information about the patient’s need for osteoporosis drugs in 15 consultations (39%), with less personalisation about the side effects/harms (n = 10,26%), or practical issues (n = 6,16%) associated with osteoporosis drugs. Clinical consultations rarely considered key personal determinants of osteoporosis drug uptake and commitment. Even when clinicians used an osteoporosis decision aid, few discussions specifically elicited or addressed patients’ personal treatment necessity beliefs, concerns and practical difficulties. Additionally, clinicians seldom acknowledged the potential physical and psychosocial impacts of osteoporosis. The findings demonstrate the need for multicomponent interventions, incorporating the PAPA-based approach, to facilitate shared decision-making that takes account of patient perceptions and practicalities. Disclosure A.W. Hawarden: Grants/research support; AH is funded by a Versus Arthritis Clinical Doctoral Fellowship (grant reference 227260). L. Bullock: None. M. León-García: Grants/research support; ML-G had financial support from the Spanish Health Institute Carlos III (ISCIII) co-funded by the European Regional Development Fund (Grant number: F18/00014).. S.A. Hartasanchez: None. I. Hargraves: None. R. Horne: None. A. Maraboto: None. M. Kunneman: Grants/research support; MK had financial support from the Dutch Research Council (NWO) and The Netherlands Organisation for Health Research and Development (ZonMw) (#016.196.138). C. Jinks: Grants/research support; CJ is part funded by NIHR Applied Research Collaboration (ARC) West Midlands. Z. Paskins: Grants/research support; ZP is funded by the National Institute for Health Research (NIHR) [Clinician Scientist Award (CS-2018-18-ST2-010)/NIHR Academy].