What is shared in shared decision making? Complex decisions when the evidence is unclear

Area of Science:

• Healthcare Decision-Making
• Patient-Centered Care
• Clinical Communication

Background:

• Patient involvement is central to patient-centered care.
• Complex clinical situations present challenges to informed decision-making due to ambiguity and inadequate evidence.
• Patient preferences can be unclear in uncertain clinical contexts.

Purpose of the Study:

• To explore how clinicians can enhance patient autonomy in complex decision-making scenarios.
• To examine the role of intuitive and deliberative processes in patient decision-making.
• To understand how collaborative cognition shapes patient preferences.

Main Methods:

• Conceptual analysis of decision-making in complex and ambiguous clinical situations.
• Exploration of "whole mind" (intuitive and deliberative) and "shared mind" (collaborative cognition) approaches.
• Discussion of the relational and dynamic nature of clinical decisions.

Main Results:

• Patient preferences are influenced by affect, framing, and collaborative cognition.
• Decisions in complex situations are often relational, dynamic, iterative, provisional, and conditional.
• Clinicians can foster autonomy by engaging both intuitive and deliberative processes and involving others in preference clarification.

Conclusions:

• Effective decision-making involves engaging patients' "whole mind" and "shared mind".
• Clinical and interpersonal relationships are crucial for promoting effective decision-making by tailoring information and identifying preference shifts.
• Information technology and health systems have potential to enhance decision-making relationships and conversations.