Eliciting patient preferences in shared decision-making (SDM): Comparing conversation analysis and SDM measurements

Area of Science:

• Medical Communication
• Health Psychology
• Decision Science

Background:

• Shared decision-making (SDM) is crucial for patient-centered care.
• Accurate measurement of SDM, particularly eliciting patient preferences, remains challenging.
• Physician communication strategies significantly influence patient involvement in treatment decisions.

Purpose of the Study:

• To investigate how physicians elicit patient preferences during clinical encounters.
• To analyze the alignment between physician hypothesis formulation about preferences and quantitative measures of SDM.
• To understand the impact of these elicitation methods on patient choice and SDM assessment.

Main Methods:

• Qualitative conversation analysis (CA) of physician-patient interactions.
• Quantitative assessment of shared decision-making (SDM) using OPTION(5) and MAPPIN'SDM tools.
• Comparison of qualitative findings with quantitative SDM scores to identify communicative actions.

Main Results:

• Physicians sometimes hypothesize patient preferences and present options accordingly (e.g., "if you think X, we can do Y").
• This approach can promote SDM by linking decisions to preferences but may also constrain patient autonomy.
• Hypothesis formulation can pressure patients towards physician recommendations, potentially explaining variations in SDM scores.

Conclusions:

• Eliciting patient preferences is complex and difficult to quantify accurately.
• Detailed analysis, like CA, reveals nuances in preference elicitation and its effect on patient involvement.
• Comparing CA with SDM measurements can refine our understanding of the communicative underpinnings of SDM scores.