The concept of negotiation in shared decision making

Area of Science:

• Medical Ethics
• Health Communication
• Clinical Decision-Making

Background:

• Shared decision-making (SDM) is central to modern medical consultations.
• The concept of negotiation is frequently used to define patient-professional interactions during conflict within SDM.
• Existing definitions of negotiation in SDM lack clarity, being variously interpreted as rational deliberation or bargaining.

Purpose of the Study:

• To critically evaluate whether rational deliberation or bargaining accurately describes negotiation in shared decision-making.
• To explore alternative frameworks for understanding the interaction between patients and healthcare professionals during SDM.

Main Methods:

• Conceptual analysis of the term 'negotiation' within the context of shared decision-making.
• Examination of descriptive and normative accuracy of rational deliberation and bargaining models in SDM.

Main Results:

• The study found that neither rational deliberation nor bargaining accurately describes the negotiation process in shared decision-making.
• Both descriptive and normative grounds show limitations in applying these models to SDM interactions.
• The concept of negotiation in SDM is deemed insufficient and potentially misleading.

Conclusions:

• The interaction in shared decision-making is more accurately characterized as an internal balancing of values by the healthcare professional.
• Key values include patient best interest, patient autonomy, and patient adherence.
• This internal balancing, when accepted by the patient, provides a more precise understanding of SDM dynamics.