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Ethical principles are essential in guiding nurses to fulfill their responsibilities, focusing on the quality of nursing care and decision-making. These principles, including autonomy, beneficence, non-maleficence, justice, and fidelity, shape the ethical framework within healthcare settings.
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Exploring shared decision making in breast cancer care.

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Shared decision making (SDM) in breast cancer treatment often fails due to conversational dynamics that hinder patient participation. Clinicians

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Area of Science:

  • Healthcare communication
  • Medical sociology
  • Conversation analysis

Background:

  • Shared decision making (SDM) is the standard for preference-sensitive care, like breast cancer treatment.
  • Patient experiences reveal a gap between clinician goals and patient empowerment in SDM.
  • Understanding conversational dynamics is crucial for effective SDM.

Purpose of the Study:

  • To identify interactional features and social practices enabling or hindering SDM in breast cancer treatment.
  • To analyze the conversational dynamics of SDM in adjuvant breast cancer consultations.

Main Methods:

  • Conversation analysis (CA) of 15 audio-recorded adjuvant breast cancer consultations.
  • Identification of recurrent interactional patterns relevant to SDM.

Main Results:

  • Linguistic cues (boundary markers, rhetorical questions, epistemic markers) discouraged patient participation.
  • Opportunities for SDM were missed, leading to suboptimal two-way discussions.
  • Interactional practices did not foster genuine patient contribution, resulting in expert-led decision-making.

Conclusions:

  • SDM in breast cancer treatment is not as collaborative as theoretical models suggest.
  • Conversational dynamics significantly impact the effectiveness of SDM.
  • Further research is needed to improve SDM practices and patient involvement.