Background Subacromial pain syndrome (SAPS) is the most common shoulder pain condition in primary care). Although exercise is the recommended first-line treatment, the absence of a universally superior option underscores the need for personalized care facilitated by shared decision-making (SDM). Despite the importance of SDM is increasingly recognized, its application in SAPS care remains poorly understood. The primary aim of this study was to explore the influence of a decision aid on patient and observer perceptions of SDM in the primary care management of patients with SAPS. Furthermore, the study aimed to explore correlations between patients’ and observers’ ratings of SDM.

Methods We conducted a multi-methods study including observations of consenting patients with SAPS in their clinical consultations with clinicians from four Danish primary care practices, using OPTION-12. Additionally, we gathered patients’ perceptions of SDM two weeks after the consultation using an online survey using the 3-item CollaboRATE questionnaire and the 9-item Shared Decision-Making Questionnaire (SDM-Q-9). We observed consultations both with and without the introduction of a decision aid tailored to support the management of patients with SAPS.

Results Thirty-four consultations were observed (16 with the decision aid, 18 without). Without the decision aid, the mean (SD) OPTION-12 score was low 10.5 + 3.3, and the median (IQR) CollaboRATE and mean (SD) SDM-Q-9 scores were 5 (IQR = 1.3) and 22.2 + 7.5, respectively. We observed higher scores in the consultations with the decision aid; the mean (SD, range) OPTION-12 score statistically significantly increased to 22.7 (6.87, 5-32), and the median (IQR) CollaboRATE and mean (SD) SDM-Q-9 scores were 6.5 (1.4) and 30.6 + 8.4, respectively. There was a positive and statistically significant correlation between patients’ and observers’ ratings of OPTION-12 and SDM-Q-9 scores across both phases. No significant correlation was found between CollaboRATE, OPTION-12, and SDM-Q-9 in either phase.

Conclusion A decision aid significantly improved observer- and patient-rated SDM in primary care consultations for patients with SAPS. Observer-rated SDM scores more than doubled with the decision aid, and patients reported higher levels of SDM. These findings highlight the potential of decision aids to enhance SDM in SAPS care.

The authors have declared no competing interest.

This study was funded by Novo Nordisk Foundation, TrygFonden, Danish Association of Physiotherapy and Aalborg University. NEF is funded through an Australian National Health and Medical Research Council (NHMRC) Investigator Grant (ID: 2018182). JRZ is funded through an NHMRC Investigator Grant (ID: APP1194105). None of the funders were involved in the research. The sponsor, Aalborg University, is non-commercial and declares no conflicts of interest.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study was conducted in accordance with the principles outlined in the Declaration of Helsinki and was considered exempt from full ethical review by the North Denmark Region Committee on Health Research Ethics (reference number: 2023-000206).

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Support and Sponsor This study was funded by Novo Nordisk Foundation, TrygFonden, Danish Association of Physiotherapy and Aalborg University. NEF is funded through an Australian National Health and Medical Research Council (NHMRC) Investigator Grant (ID: 2018182). JRZ is funded through an NHMRC Investigator Grant (ID: APP1194105). None of the funders were involved in the research. The sponsor, Aalborg University, is non-commercial and declares no conflicts of interest.

All data produced in the present study are not available.