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Navigating the Decision Space: Shared Medical Decision Making as Distributed Cognition.

Katherine D Lippa1, Markus A Feufel2, F Eric Robinson1

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Summary

Shared decision making involves cognitive processes where patients and physicians distribute decision-making tasks. Understanding these cognitive processes can improve patient care and medical training.

Keywords:
Multiple SclerosisNorth Americachronic diseasecognitiondecision makingdoctor–patient communication and relationsemergency caregrounded theoryqualitative

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Area of Science:

  • Cognitive Science
  • Medical Decision Making
  • Distributed Cognition

Background:

  • Shared decision making (SDM) is increasingly important but poorly understood cognitively.
  • Existing research lacks a framework for analyzing the cognitive underpinnings of SDM.

Purpose of the Study:

  • To investigate the cognitive processes in shared decision making.
  • To conceptualize SDM as a form of distributed cognition.
  • To introduce a Decision Space Model for analyzing influences on decision making.

Main Methods:

  • Employed field observations and interviews in acute and chronic care settings.
  • Developed a Decision Space Model to identify physical and social influences.
  • Analyzed decision-making patterns based on information and action distribution.

Main Results:

  • Patients and physicians consider physical and social influences during decision making.
  • Identified four decision-making patterns: physician-dominated, physician-defined/patient-made, patient-defined/physician-made, and patient-dominated.
  • Decision making is inherently distributed, requiring integration of patient and physician reasoning.

Conclusions:

  • Shared decision making is a distributed cognitive process requiring integration of patient and physician perspectives.
  • Failures in integrating reasoning can lead to adverse outcomes.
  • Findings have implications for enhancing patient care and medical education.