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

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

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)217-228
Number of pages12
JournalCommunication and Medicine
Volume14
Issue number3
DOIs
StatePublished - Jan 1 2017

Fingerprint

Decision Making
Hydroxyurea
Physicians
Decision Support Techniques
Medical Records

Keywords

  • Conversation analysis
  • Patient-provider communication
  • SDM framework
  • Shared decision making, sickle cell disease

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

What does shared decision making look like in natural settings? A mixed methods study of patient-provider conversations. / Lee, Joy; Callon, Wynne; Haywood, Carlton; Lanzkron, Sophie M.; Gulbrandsen, Pål; Beach, Mary Catherine.

In: Communication and Medicine, Vol. 14, No. 3, 01.01.2017, p. 217-228.

Research output: Contribution to journalArticle

Lee, Joy ; Callon, Wynne ; Haywood, Carlton ; Lanzkron, Sophie M. ; Gulbrandsen, Pål ; Beach, Mary Catherine. / What does shared decision making look like in natural settings? A mixed methods study of patient-provider conversations. In: Communication and Medicine. 2017 ; Vol. 14, No. 3. pp. 217-228.
@article{159196a0fcd44bcdb847e6176cca91c0,
title = "What does shared decision making look like in natural settings? A mixed methods study of patient-provider conversations",
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.",
keywords = "Conversation analysis, Patient-provider communication, SDM framework, Shared decision making, sickle cell disease",
author = "Joy Lee and Wynne Callon and Carlton Haywood and Lanzkron, {Sophie M.} and P{\aa}l Gulbrandsen and Beach, {Mary Catherine}",
year = "2017",
month = "1",
day = "1",
doi = "10.1558/cam.32815",
language = "English (US)",
volume = "14",
pages = "217--228",
journal = "Communication and Medicine",
issn = "1612-1783",
publisher = "Equinox Publishing Ltd",
number = "3",

}

TY - JOUR

T1 - What does shared decision making look like in natural settings? A mixed methods study of patient-provider conversations

AU - Lee, Joy

AU - Callon, Wynne

AU - Haywood, Carlton

AU - Lanzkron, Sophie M.

AU - Gulbrandsen, Pål

AU - Beach, Mary Catherine

PY - 2017/1/1

Y1 - 2017/1/1

N2 - 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.

AB - 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.

KW - Conversation analysis

KW - Patient-provider communication

KW - SDM framework

KW - Shared decision making, sickle cell disease

UR - http://www.scopus.com/inward/record.url?scp=85058554669&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85058554669&partnerID=8YFLogxK

U2 - 10.1558/cam.32815

DO - 10.1558/cam.32815

M3 - Article

AN - SCOPUS:85058554669

VL - 14

SP - 217

EP - 228

JO - Communication and Medicine

JF - Communication and Medicine

SN - 1612-1783

IS - 3

ER -