Factors influencing Autonomy Supportive consultation: a realist review

Introduction Traditionally the patient - healthcare professional relationship was paternalistic, in which the professional made the decisions on behalf of the client. There has been a paradigm shift away from this type of encounter toward a more patient-centered care, in which the patient is more empowered, informed, and autonomous. However, there is room for improvement in the way professionals facilitate patient’s empowerment and autonomy during consultation (Martin et al, 2018). By autonomy supportive consultation professionals facilitate more autonomous forms of self-regulation (Ng et al, 2012). The aim of this review is to determine how contextual factors support or hinder the development of an autonomy-supportive climate and identify the factors which influence the mechanisms to support patients autonomy before, during and after decisionmaking in consultations and the outcomes. Methods We conducted a realist review which allowed us to analyze heterogeneous evidence to understand an underlying mechanism. The data are analyzed using the model of context, mechanism and outcome. Literature searches were performed in Pubmed, Embase, PsycINFO and Cinahl. The search terms used were autonomy, support, consultation/communication and intervention. Results Out of 2200 articles we found,16 articles met the inclusion criteria. We first looked at the context and found that work organization, the attitude and competence of a professional are important factors for creating an autonomy-supportive climate during a consultation. As mechanism we found as most important overarching factor knowing the client, the most important factor related to the process of decision-making was respectful interaction on rational and emotional issues. Two important patient outcomes we found were higher perceived decision satisfaction and higher compliance for treatment or behavior change. Discussion & Conclusion Healthcare providers hardly offer autonomy support during consultation. We found that to realize an autonomy-supportive climate the attitude and competence of professionals are important. To facilitate the transition to become a more autonomy-supportive professional, training is required. Based on these new insights into context and mechanisms of autonomy support we intend to developed a framework for training. References Martin Linda, Gitsels-van der Wal Janneke, De Boer Marion A, Vanstone Meredith, Henneman Lidewij. Introduction of non-invasive prenatal testing as a first-tier aneuploidy screening test: A survey among Dutch midwives about their role as counsellors. Midwifery 2018; 56: 1-8 NG Johan Y, Ntoumanis Nikos, Thogersen-Ntoumani Cecilie, Deci Edward L, Ryan Richard M, Duda Joan l, Williams, Geoffrey C. Self-Determination Theory Applied to Health Contexts: A Meta-Analysis. Perpectives on Psychological Science. 2012;7(4):325-340