Feasibility and acceptability of an everyday patient-centered discussion model for primary care: An exploratory, single-center study in the VA primary care setting.
The ZIP approach allows for quick, patient-centered discussions in primary care, with patients reporting high satisfaction in shared decision-making.
Where it sits
this study against the rest of the semaglutide corpusSummary and findings
This study assessed the feasibility and acceptability of the ZIP approach for patient-centered decision-making in lung cancer screening and blood pressure management. It involved 23 patients and 10 primary care physicians in a single center study. The ZIP discussions took less than 4 minutes on average.
Abstract
Objectives Primary care visits average 15 min or less, limiting physician time for engaging in detailed shared decision-making. The ZIP approach-Zeroing in on Individualized, Patient-Centered Decisions-offers a practical path to improving decisions within time constraints. This study assesses the feasibility and acceptability of the ZIP approach in facilitating patient-centered decision-making for lung cancer screening (LCS) and blood pressure (BP) management in primary care. Methods Multiple-methods study using audio-recorded primary care appointments and patient and physician feedback from surveys and semi-structured interviews. 23 patients who were eligible for an initial LCS (n = 4) or BP medication intensification (n = 19) and 10 primary care physicians were enrolled in a single center study in a VA medical center. Feasibility was assessed through observing duration (in minutes) for initial ZIP presentation, total conversation, completion of ZIP components, and patient-survey-based SDM measure (SDM-Q-9). Acceptability was assessed through conducting thematic analysis of patient and physician interviews. Results ZIP discussions took less than 4 min. The median time for the initial ZIP presentation was 1.8 min (IQR) for LCS and 2 min (IQR) for BP conversations. Almost half of the encounters (43%; n = 9/21) had perfect ZIP fidelity scores (median = 9/10); The mean SDM-Q-9 score, reflecting patients' perceptions of the extent of SDM during the appointment, was 90.9 out of 100. Patients reported valuing personalized communication, trust, and collaborative decision-making. Physicians perceived that the SDM discussions were shorter, appreciated the tailored information and data visualizations, but suggested improvements to better align ZIP with conversational flow. Conclusions The ZIP approach is a promising method for facilitating brief, patient-centered discussions in primary care. Its high acceptability among patients and physicians suggests strong potential for improving decision quality across diverse preventive care topics. Innovation ZIP introduces a novel framework for integrating shared decision-making into routine care by addressing longstanding implementation barriers. Future research should examine scalability across diverse settings and evaluate sustainable approaches to integrate ZIP guidance into primary care.
Background
The study addresses the challenge of limited time during primary care visits, which typically last 15 minutes or less. Prior research has indicated that this constraint hampers effective shared decision-making (SDM) between patients and physicians. The ZIP approach aims to enhance patient-centered discussions, particularly for lung cancer screening and blood pressure management, making this study relevant for improving clinical practice.
Methods
This was a multiple-methods study conducted in a single VA medical center. It involved 23 patients eligible for lung cancer screening (n=4) or blood pressure medication intensification (n=19) and 10 primary care physicians. Feasibility was assessed by measuring the duration of ZIP presentations and conversations, completion of ZIP components, and patient perceptions of SDM using the SDM-Q-9. Acceptability was evaluated through thematic analysis of interviews.
Results
The primary endpoint showed that ZIP discussions took less than 4 minutes, with a median time of 1.8 minutes for lung cancer screening and 2 minutes for blood pressure management. The mean SDM-Q-9 score was 90.9 out of 100, indicating high patient perception of SDM during appointments. Almost half of the encounters achieved perfect ZIP fidelity scores.
Interpretation
The findings suggest that the ZIP approach may facilitate brief yet effective patient-centered discussions in primary care, aligning with previous literature that emphasizes the importance of SDM. However, while the SDM-Q-9 score indicates a high level of perceived engagement, the clinical significance of such a score should be interpreted cautiously. The small sample size and single-center nature of the study limit the robustness of these conclusions and their applicability to broader settings.
Key findings
- Median time for initial ZIP presentation was 1.8 min (IQR) for lung cancer screening and 2 min (IQR) for blood pressure conversations.
- 43% of encounters (n=9/21) had perfect ZIP fidelity scores (median=9/10).
- Mean SDM-Q-9 score was 90.9 out of 100.
Limitations
- Small sample size of 23 patients.
- Single-center study may limit generalizability.
- No long-term follow-up data reported.