Where is the problem to be solved? Problem defining and epistemic uncertainties in shared decision-making

Area of Science:

• Oncology
• Medical Sociology
• Health Communication

Background:

• Physicians and patients possess distinct yet overlapping knowledge bases influencing cancer treatment problem definition.
• Divergent problem definitions arise from differing contextual knowledge application during cancer care.

Purpose of the Study:

• To identify the knowledge sources utilized by physicians and patients in defining problems within shared decision-making for cancer treatment.
• Investigate the origins of differing problem definitions in the physician-patient dyad during cancer therapy.

Main Methods:

• A divided narrative approach was employed.
• Interviews were conducted with 32 cancer patients and 16 paired physicians from two leading hospitals in northwestern China.

Main Results:

• Physicians' problem definitions were structured by five types of knowledge sources within the social system.
• Patients' problem definitions were grounded in five types of knowledge sources within the individual system.
• Asymmetric social mechanisms underpin knowledge utilization for problem definition, highlighting structural and cultural barriers.

Conclusions:

• Mutual understanding and trust are challenged by asymmetric knowledge application in problem definition.
• Shared problem definition can emerge from epistemic uncertainties inherent in physician-patient interactions.
• Narrative exchange at multiple levels (macro, meso, micro) offers potential solutions for problems identified in shared decision-making.
• Physicians should consider patients' cultural narratives, while patients should acknowledge physicians' social-structural perspectives in shared decision-making.