Study protocol

EXACKTE²: Exploiting the clinical consultation as a knowledge transfer and exchange environment: a study protocol

France Légaré^1,2 , Moira Stewart³ , Dominick Frosch⁴ , Jeremy Grimshaw^5,6 , Michel Labrecque^1,2 , Martine Magnan¹ , Mathieu Ouimet^1,7 , Michel Rousseau² , Dawn Stacey^5,8 , Trudy van der Weijden⁹ and Glyn Elwyn¹⁰

¹  Research Center of the Centre Hospitalier Universitaire de Québec, Québec, Canada

²  Department of Family and Emergency Medicine, Université Laval, Québec, Canada

³  Department of Family Medicine, University of Western Ontario, London, Canada

⁴  Department of Medicine, University of California, Los Angeles, USA

⁵  Ottawa Health Research Institute, Ottawa, Canada

⁶  Department of Medicine, University of Ottawa, Ottawa, Canada

⁷  Department of Political Science, Université Laval, Québec, Canada

⁸  Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Canada

⁹  Department of General Practice, School of Public Health and Primary Care (Caphri), Maastricht University, Maastricht, The Netherlands

¹⁰  Department of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, CF14 4YS, UK

author email corresponding author email

Implementation Science 2009, 4:14doi:10.1186/1748-5908-4-14

Published:	13 March 2009

Abstract

Background

While the evidence suggests that the way physicians provide information to patients is crucial in helping patients decide upon a course of action, the field of knowledge translation and exchange (KTE) is silent about how the physician and the patient influence each other during clinical interactions and decision-making. Consequently, based on a novel relationship-centered model, EXACKTE² (EXploiting the clinicAl Consultation as a Knowledge Transfer and Exchange Environment), this study proposes to assess how patients and physicians influence each other in consultations.

Methods

We will employ a cross-sectional study design involving 300 pairs of patients and family physicians from two primary care practice-based research networks. The consultation between patient and physician will be audio-taped and transcribed. Following the consultation, patients and physicians will complete a set of questionnaires based on the EXACKTE² model. All questionnaires will be similar for patients and physicians. These questionnaires will assess the key concepts of our proposed model based on the essential elements of shared decision-making (SDM): definition and explanation of problem; presentation of options; discussion of pros and cons; clarification of patient values and preferences; discussion of patient ability and self-efficacy; presentation of doctor knowledge and recommendation; and checking and clarifying understanding. Patients will be contacted by phone two weeks later and asked to complete questionnaires on decisional regret and quality of life. The analysis will be conducted to compare the key concepts in the EXACKTE² model between patients and physicians. It will also allow the assessment of how patients and physicians influence each other in consultations.

Discussion

Our proposed model, EXACKTE², is aimed at advancing the science of KTE based on a relationship process when decision-making has to take place. It fosters a new KTE paradigm by putting forward a relationship-centered perspective and has the potential to reveal unknown mechanisms that underline effective KTE in clinical contexts. This will result in better understanding of the mechanisms that may promote a new generation of knowledge transfer strategies.