An Everyday Patient-Centered Discussion Model for Primary Care: Protocol for a Feasibility and Acceptability Study of the Zeroing in on Individualized, Patient-Centered Decisions (ZIP) Approach

TL;DR

This study tests a new, time-efficient model for patient-centered decision-making in primary care to see if it's practical and well-received by doctors and patients.

Contribution

The ZIP approach introduces a concise, patient-centered decision-making model designed for real-world primary care settings.

Findings

The ZIP approach includes personalized recommendations and trade-off discussions within clinical constraints.

Feasibility and acceptability of ZIP were evaluated through pilot testing in lung cancer screening and blood pressure treatment decisions.

Qualitative and survey data will inform the potential for a larger trial of the ZIP approach.

Abstract

The Zeroing in on Individualized, Patient-Centered Decisions (ZIP) approach was developed to be a feasible, everyday shared decision-making (SDM) approach to personalizing decisions in primary care. Current SDM models, which require 5 to 10 minutes just to present initial information, are impractical in primary care, highlighting the need for more concise, patient-centered approaches. The ZIP approach preserves core aspects of SDM while offering a more pragmatic framework suited to real-world clinical constraints. This approach includes three key elements: (1) making a personalized recommendation, (2) qualitatively presenting trade-offs, and (3) supporting patient decisional autonomy. Previous work has found this approach to be acceptable. However, little is known about how feasible and acceptable the ZIP approach is during an actual primary care visit.

This paper aims to describe the protocol for a pilot test of the feasibility and acceptability to both patients and primary care physicians (PCPs) of using a paper-based deployment of the ZIP approach in a primary care clinic.

Two case studies were examined: lung cancer screening (LCS) and blood pressure (BP) treatment decisions. This study was a multicomponent pilot implementation study involving training PCPs in the ZIP approach and providing them with an encounter-based decision aid supporting the ZIP approach during clinic visits. Eligible patients were either candidates for an initial LCS conversation or a conversation about intensifying BP medication. The patient-PCP medical encounters were audio recorded. Following the appointment, the patient completed a short survey and underwent a semistructured interview. After PCPs completed 2 to 3 study appointments, they underwent a semistructured interview reflecting on their experience with the ZIP approach. Surveys and interviews sought to understand the overall ZIP components presented during the appointment (ie, feasibility) and the extent to which patients and physicians found the approach appropriate (ie, acceptability). Survey data were analyzed to provide an overview of patient and physician demographics. Interviews were transcribed and analyzed through qualitative coding and thematic analysis to identify high-level takeaways of the feasibility and acceptability of this approach.

This study was funded in October 2022 by the Department of Veterans Affairs. We recruited 10 PCPs and 23 patients (n=4, 17% patients undergoing LCS and n=19, 83% patients involved in BP treatment decision-making). Data collection took place from October 2023 to April 2024. Data analysis concluded in December 2024. Planned paper submission will occur in June 2025.

The results from this pilot implementation study will contribute to the ongoing efforts toward integrating a practical approach to SDM into primary care. This pilot will lay the groundwork for an effective and efficient larger-scale trial.

DERR1-10.2196/64998

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