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A descriptive model of shared decision making derived from routine implementation in clinical practice

Natalie Joseph-Williams1, Denitza Williams1, Fiona Wood1

  • 1Cardiff University, College of Biomedical and Life Sciences, School of Medicine, Division of Population Medicine, Cardiff, UK.

Patient Education and Counseling
|July 29, 2019
PubMed
Summary

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This summary is machine-generated.

Shared Decision-Making (SDM) in routine care is more complex than current models suggest. This study observed patient-clinician interactions, revealing a more intricate process than previously understood.

Area of Science:

  • Clinical communication research
  • Health services research

Background:

  • Shared Decision-Making (SDM) is crucial for patient-centered care but its real-world application is not fully understood.
  • Existing theoretical models may not capture the complexity of SDM in practice.

Purpose of the Study:

  • To describe the process of SDM between clinicians and patients in routine settings.
  • To compare observed SDM with prescriptive models.
  • To propose a new descriptive model of SDM based on practice.

Main Methods:

  • Audio-recorded and transcribed 76 consultations (26 chronic kidney disease, 50 breast cancer).
  • Thematic analysis of consultations to identify stages and elements of SDM.
  • Comparison of observed practices against the 'Three Talk Model' and other theoretical frameworks.
Keywords:
Breast cancerChronic kidney diseasePatient centred carePatient involvementShared decision makingSkills training

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Main Results:

  • Observed SDM involved more elements and complexity than prescriptive models.
  • Identified a distinct preparation phase, evolving option conversations, and distributed decision-making.
  • Patients and clinicians developed 'informed preferences' through a more open-ended planning discussion.

Conclusions:

  • Routine SDM is more complex and nuanced than current theoretical models portray.
  • The observed complexities include distinct preparation, evolving discussions, and multi-stage decision-making.
  • A new descriptive model is proposed to better reflect real-world SDM practices.