Beyond Preferences: Rethinking shared decision-making through the Lens of care.

Area of Science:

• Medical Sociology
• Health Humanities
• Patient-Centered Care

Background:

• Shared Decision-Making (SDM) is a cornerstone of modern healthcare, emphasizing patient involvement through preference articulation.
• Current SDM models often prioritize rational deliberation, potentially neglecting relational and affective aspects of care.

Purpose of the Study:

• To examine how patients undergoing long-term anticoagulant therapy make decisions and perceive their treatment.
• To critically analyze the concept of patient "preferences" within the framework of SDM.
• To explore alternative models of patient agency beyond rational choice.

Main Methods:

• Ethnographic fieldwork conducted in France, Spain, and Denmark.
• Study focused on patients with a history of unprovoked venous thromboembolism (VTE) on long-term anticoagulant therapy.
• Analysis informed by Annemarie Mol's "logic of care" framework.

Main Results:

• Patient "preferences" are not fixed but are fragile, contingent, and emergent responses shaped by context.
• Practitioner interpretations of preferences can obscure other forms of patient agency.
• Patient agency is exercised through ongoing, situated negotiations of treatment, extending beyond clinical consultations.

Conclusions:

• A "logic of care" approach reveals patient agency as a continuous negotiation, not merely a choice between predefined options.
• Focusing on care rather than choice allows for a more responsive approach to patient needs, demands, and hesitations.
• Healthcare engagement should broaden beyond preference articulation to embrace more context-sensitive forms of participation.