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Seeing Complexity: Cultural Historical Activity Theory (CHAT) As a Lens for Shared Decision Making.

Catherine T Witkop1, Lauren A Maggio2, Emily J Harvey3

  • 1C.T. Witkop is professor of preventive medicine and obstetrics/gynecology and associate dean for medical education, Uniformed Services University of the Health Sciences, Bethesda, Maryland; ORCID: http://orcid.org/0000-0001-5366-2663 .

Academic Medicine : Journal of the Association of American Medical Colleges
|May 13, 2021
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Summary

Cultural Historical Activity Theory (CHAT) offers a new framework to understand shared decision making (SDM) complexity. Applying CHAT can improve patient-provider collaboration and educational strategies in healthcare.

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Area of Science:

  • Health Professions Education
  • Sociology
  • Psychology

Background:

  • Shared decision making (SDM) is a collaborative process between patients and providers, crucial for patient-centered care but often hindered by educational gaps.
  • Existing educational interventions for SDM show inconsistent effectiveness, suggesting a need for more nuanced theoretical frameworks.
  • The complexity of SDM arises from the interplay of individual patient agency and sociocultural contexts, which traditional approaches may overlook.

Purpose of the Study:

  • To introduce Cultural Historical Activity Theory (CHAT) as a framework for analyzing the complexities of shared decision making.
  • To demonstrate how CHAT can illuminate the multivoiced nature of SDM and identify barriers to its effective implementation.
  • To propose CHAT as a tool for future research and the design of innovative instructional strategies in health professions education.

Main Methods:

  • The study identifies and explains Cultural Historical Activity Theory (CHAT) as a suitable theoretical lens for examining SDM.
  • A fictitious case study is presented, illustrating the application of CHAT to analyze the interactions within a patient's and physician's activity systems during a clinical encounter.
  • The analysis highlights inherent tensions and contradictions within the SDM process using the CHAT framework.

Main Results:

  • CHAT provides a robust lens for appreciating the complexity and multivoiced nature of shared decision making.
  • The application of CHAT reveals critical insights into the interacting activity systems of patients and physicians, exposing underlying tensions.
  • The analysis demonstrates how CHAT can identify specific barriers and opportunities within the SDM process.

Conclusions:

  • Cultural Historical Activity Theory (CHAT) offers a valuable framework for researchers and educators to examine and improve shared decision making.
  • CHAT can serve as a tool for future research on patient agency and other complex health topics.
  • The framework has significant potential for designing novel and effective instructional strategies in health professions education.