Item Details

What does shared decision making look like in natural settings? A mixed methods study of patient–provider conversations

Issue: Vol 14 No. 3 (2017)

Journal: Communication & Medicine

Subject Areas: Healthcare Communication Linguistics

DOI: 10.1558/cam.32815

Abstract:

Objective: To understand the variability and nature of shared decision making (SDM) regarding a uniform type of serious medical decision, and to make normative judgments about how these conversations might be improved. Methods: This was a mixed-methods sub-analysis of the Improving Patient Outcomes with Respect and Trust (IMPORT) study. We used the Braddock framework to identify and describe seven elements of SDM in audio-recorded encounters regarding initiation of hydroxyurea, and used data from medical records and patient questionnaires to understand whether and how these tasks were achieved. Results: Physicians covered a spectrum of SDM behaviors: all dialogues contained discussion regarding the clinical issue and the pros and cons of treatment; the patient's understanding and role were not explicitly assessed or stated in any encounter. Yet no patient agreed to start hydroxyurea who did not already prefer it. There was no uniform approach to how physicians presented risk; many concerns expressed by patients in a pre-visit questionnaire were not discussed. Conclusion: In this analysis, patients seemed to understand their role in the decision-making process, suggesting that a patient's role may not always need to be explicitly stated. However, shared decision making might be improved with more routine assessment of patient understanding and concerns. Standardized decision aids might help fully inform patients of risks and benefits.

Author: Joy Lee, Wynne Callon, Carlton Haywood, Jr., Sophie M. Lanzkron, Pål Gulbrandsen, Mary Catherine Beach

View Original Web Page

References :

Bauer, A. M., Parker, M. M., Schillinger, D., Katon, W., Adler, N., Adams. A. S., Moffet, H. H. and Karter, A. J. (2014) Associations between antidepressant adherence and shared decision-making, patient-provider trust, and communication among adults with diabetes: Diabetes study of Northern California (DISTANCE). Journal of General Internal Medicine 29 (8): 1139–1147. https://doi.org/10.1007/s11606-014-2845-6

Bieber, C., Nicolai, J., Hartmann, M., Blumenstiel, K., Ringel, N., Schneider. A., Härter, M., Eich, W. and Loh, A. (2009) Training physicians in shared decision-making? Who can be reached and what is achieved? Patient Education and Counseling 77 (1): 48–54. https://doi.org/10.1016/j.pec.2009.03.019

Braddock, C. H., Edwards, K. A., Hasenberg, N. M., Laidley, T. L. and Levinson, W. (1999) Informed decision making in outpatient practice: Time to get back to basics. Journal of the American Medical Association 282 (24): 2313–2320. https://doi.org/10.1001/jama.282.24.2313

Collins, S., Drew, P., Watt, I. and Entwistle, V. (2005) ‘Unilateral’ and ‘bilateral’ practitioner approaches in decision-making about treatment. Social Science & Medicine 61 (12): 2611–2627. https://doi.org/10.1016/j.socscimed.2005.04.047

Dyche, L. and Swiderski, D. (2005) The effect of physician solicitation approaches on ability to identify patient concerns. Journal of General Internal Medicine 20 (3): 267–270. https://doi.org/10.1111/j.1525-1497.2005.40266.x

Elwyn, G., Edwards, A., Mowle, S., Wensing, M., Wilkinson, C., Kinnersley. P. and Grol, R. (2001) Measuring the involvement of patients in shared decision-making: A systematic review of instruments. Patient Education and Counseling 43 (1): 5–22. https://doi.org/10.1016/S0738-3991(00)00149-X

Elwyn, G., Frosch, D., Thomson, R., Joseph-Williams, N., Lloyd, A., Kinnersley, P., Cording, E., Tomson, D., Dodd, C., Rollnick, S., Edwards, A. and Barry, M. (2012) Shared decision making: A model for clinical practice. Journal of General Internal Medicine 27 (10): 1361–1367. https://doi.org/10.1007/s11606-012-2077-6

Gulbrandsen, P., Dalby, A. M. L., Ofstad, E. H. and Gerwing, J. (2014) Confusion in and about shared decision making in hospital outpatient encounters. Patient Education and Counseling 96 (3): 287–294. https://doi.org/10.1016/j.pec.2014.07.012

Herrmann, A., Mansfield, E., Hall, A. E., Sanson-Fisher, R. and Zdenkowski, N. (2016) Wilfully out of sight? A literature review on the effectiveness of cancer-related decision aids and implementation strategies. BMC Medical Informatics and Decision Making 16 (1): 36. https://doi.org/10.1186/s12911-016-0273-8

Hornberger, J., Thom, D. and MaCurdy, T. (1997) Effects of a self-administered previsit questionnaire to enhance awareness of patient’s concerns in primary care. Journal of General Internal Medicine 12 (10): 597–606. https://doi.org/10.1046/j.1525-1497.1997.07119.x

Landmark, A. M. D., Svennevig, J. and Gulbrandsen, P. (2016) Negotiating treatment preferences: Physicians’ formulations of patients’ stance. Social Science & Medicine 149: 26–36. https://doi.org/10.1016/j.socscimed.2015.11.035

Matthias, M. S., Salyers, M. P. and Frankel, R. M. (2013) Re-thinking shared decision-making: Context matters. Patient Education and Counseling 91 (2): 176–179. https://doi.org/10.1016/j.pec.2013.01.006

Mendick, N., Young, B., Holcombe, C, and Salmon, P. (2010) The ethics of responsibility and ownership in decision-making about treatment for breast cancer: Triangulation of consultation with patient and surgeon perspectives. Social Science & Medicine 70 (12): 1904–1911. https://doi.org/10.1016/j.socscimed.2009.12.039

Middleton, J. F., McKinley, R. K. and Gillies, C. L. (2006) Effect of patient completed agenda forms and doctors’ education about the agenda on the outcome of consultations: Randomised controlled trial. British Medical Journal 332 (7552): 1238–1242. https://doi.org/10.1136/bmj.38841.444861.7C

Nathan, A. G., Marshall, I. M., Cooper, J. M. and Huang, E. S. (2016) Use of decision aids with minority patients: A systematic review. Journal of General Internal Medicine 31 (6): 663–676. https://doi.org/10.1007/s11606-016-3609-2

National Heart, Lung, and Blood Institute (2014) Evidence-Based Management of Sickle Cell Disease. Retrieved from https://www.nhlbi.nih.gov/sites/www.nhlbi.nih.gov/files/sickle-cell-disease-report%20020816.pdf

Nota, I., Drossaert, C. H. C., Taal, E., Vonkeman, H. E., Haagsma, C. J. and van de Laar, M. A. F. J. (2016) Evaluation of a patient decision aid for initiating disease modifying anti-rheumatic drugs. Arthritis Research & Therapy 18 (1): 252. https://doi.org/10.1186/s13075-016-1138-3

Pilnick, A. and Dingwall, R. (2011) On the remarkable persistence of asymmetry in doctor/patient interaction: A critical review. Social Science & Medicine 72 (8): 1374–1382. https://doi.org/10.1016/j.socscimed.2011.02.033

Pilnick, A. and Zayts, O. (2016) Advice, authority and autonomy in shared decision-making in antenatal screening: The importance of context. Sociology of Health & Illness 38 (3): 343–359. https://doi.org/10.1111/1467-9566.12346

Robertson, M., Moir, J., Skelton, J., Dowell, J. and Cowan, S. (2011) When the business of sharing treatment decisions is not the same as shared decision making: A discourse analysis of decision sharing in general practice. Health 15 (1): 78–95. https://doi.org/10.1177/1363459309360788

Stacey, D., Légaré, F., Lewis, K., Barry, M. J., Bennett, C. L., Eden. K. B., Holmes-Rovner, M., Llewellyn-Thomas, H., Lyddiatt, A., Thomson, R. and Trevena, L. (2017) Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews 4 (9): CD001431. https://doi.org/10.1002/14651858.CD001431.pub5

Trikalinos, T. A., Wieland, L. S., Adam, G. P., Zgodic, A. and Ntzani, E. E. (2014) Decision Aids for Cancer Screening and Treatment. AHRQ Comparative Effectiveness Reviews 15-EHC002-EF. Rockville, MD: Agency for Healthcare Research and Quality.

Volk, R. J., Linder, S. K., Lopez-Olivo, M. A., Kamath, G. R., Reuland, D. S., Saraykar, S. S., Leal, V. B. and Pignone, M. P. (2016) Patient decision aids for colorectal cancer screening. American Journal of Preventive Medicine 51 (5): 779–791. https://doi.org/10.1016/j.amepre.2016.06.022

Whitney, S. N., McGuire, A. L. and McCullough, L. B. (2004) A typology of shared decision making, informed consent, and simple consent. Annals of Internal Medicine 140 (1): 54–59. https://doi.org/10.7326/0003-4819-140-1-200401060-00012

Wilson, S. R., Strub, P., Buist, A. S., Knowles, S. B., Lavori, P. W., Lapidus, J., Vollmer, W. M. and Better Outcomes of Asthma Treatment (BOAT) Study Group. (2012) Shared treatment decision making improves adherence and outcomes in poorly controlled asthma. American Journal of Respiratory and Critical Care Medicine 181 (6): 566–577. https://doi.org/10.1164/rccm.200906-0907OC