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Table 4 Key findings from four studies assessing perceived decision difficulty

From: Perceived difficulty and appropriateness of decision making by General Practitioners: a systematic review of scenario studies

First author, year, country Study design (interventions assessed) Number of GPs and scenarios Decision made and difficulty assessment Decision results Decision difficulty results
Bonetti 2005, UK [16] RCT (A&F & ERM) Baseline 214 GPs, 10 scenarios Order lumbar x-ray for back pain (yes or no) Yes decisions summed per GP Scores summed per GP
Follow-up 10-point difficulty scalea Baseline mean scores: Baseline mean scores:
152 GPs, 10 scenarios No A&F 3.59; A&F 3.70 No A&F 40.09; A&F 39.53
No ERM 3.75; ERM 3.55 No ERM 40.82; ERM 38.77
Follow-up mean scores: Follow-up mean scores:
No A&F 3.47; A&F 3.14* No A&F 41.16; A&F 38.61*
No ERM 3.60; ERM 3.01* No ERM 40.31; ERM 39.46
Carroll 2011, Canada [17] RCT (KT) Baseline 80 GPs, 10 scenarios Refer women with different HBOC risk (yes or no) Appropriate decisions summed per GP Scores summed per GP
Follow-up 7-point difficulty scalea Baseline mean scores: Baseline mean scores:
80 GPs, 10 scenarios   Control 7.1; KT 6.5 Control: 30.7; KT: 32.8
Follow-upb mean scores: Follow-upb mean scores:
Control 6.4; KT 7.8* Control: 33.4; KT: 29.7
Short 2003, UK [20] Before & after (CDSS) 15 GPs, 10 scenarios Prescribe aspirin for stroke (15 point scalec) Across 9 scenarios where prescribing appropriate, overall shift 116 points towards prescribing Mean scale scores:
5-point difficulty scaled,e Before = 2.7; After = 3.1
Lynggaard 2006, Denmark [19] Questionnairef 55 GPs, 5 scenarios Prescribe for hypertension % GPs prescribing per scenario: % ‘easy’ decisions per scenario:
3-point difficulty scaleg 96%; 85%; 96%; 56%; 63% 83%; 67%; 80%; 50%; 50%
  1. Note: A&F = audit & feedback; CDSS = computerised decision support system; ERM = educational reminder messages; HBOC = hereditary breast & ovarian cancer; KT = knowledge translation; RCT = randomised controlled trial.
  2. *p < .05.
  3. aNot at all difficult to extremely difficult.
  4. bAdjusted for baseline imbalance between the intervention and control group.
  5. cYes aspirin to no aspirin, with unsure at mid-point.
  6. dStrongly disagree to strongly agree prescribing decisions easy to make (assessed in relation to decisions overall, not per scenario).
  7. eBoth scales adapted from scales developed by the Ottawa Hospital Research Institute.
  8. fAdapted from Hamilton-Craig and colleagues [21].
  9. gHard, moderate, easy.
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