Shared decision making observed in clinical practice: visual displays of communication sequence and patterns

Area of Science:

• Medical Communication
• Health Services Research
• Patient-Centered Care

Background:

• Effective communication is crucial in healthcare.
• Shared decision-making (SDM) models aim to involve patients in treatment choices.
• Understanding GP communication strategies in SDM is essential for improving patient care.

Purpose of the Study:

• To analyze general practitioners' (GPs) communication strategies during patient consultations.
• To compare observed communication practices with theoretical frameworks of shared decision-making.
• To identify discrepancies and novel elements in the application of SDM in primary care.

Main Methods:

• Analysis of transcribed consultations from four experienced GPs focused on patient involvement.
• Coding of communication skills and sequential banding for visual display.
• Comparison of empirical data with established theoretical competences for shared decision-making.

Main Results:

• Observed GP communication strategies did not fully align with theoretical SDM frameworks.
• Key stages identified include problem definition, portrayal of equipoise, information exchange, and follow-up planning.
• Patient preferences and roles in decision-making were not consistently explored.
• Longer consultations (>11 min) facilitated more information exchange and patient interaction.

Conclusions:

• Theoretical SDM competences may not be fully represented in current clinical practice.
• The 'portrayal of equipoise' emerged as a significant, previously undescribed interactional stage.
• Optimizing SDM may necessitate longer consultation times or strategies for information exchange beyond the traditional visit.