"The Doctor Helped Me Decide": A Linguistic Analysis of Contraceptive Shared Decision-Making Narratives in Clinical...

Shared decision-making, in which a patient's values and preferences facilitate the co-construction of a clinical decision, is a key component of patient-centered care and is of pedagogical interest in medical training. Yet, barriers exist to implementation, with limited information about how patients understand and exert agency. To help educators and health professionals facilitate shared decision-making, we examined how patients narrate their agentic experiences and the roles of their physician and a decision aid mobile application (app) in contributing to agency when engaged in contraceptive clinical encounters.

We conducted a qualitative study of 21 female patients, aged 17-45, who utilized a decision aid app before an encounter for contraceptive services. We conducted linguistic analysis of semi-structured interviews where patients narrated their decision-making experiences, by coding for linguistic markers of agency.

Patients narrated individual agency, identifying agentive tasks required for decision-making, including gaining knowledge, asking questions, voicing needs, and making choices. Patients narrated the app as a source of information, identifying questions, validating previous knowledge/opinions, and as surrogate provider. Patients narrated physicians as supportive agents, cueing patient agency and actions during the visit. Joint agency of patient and physician and agency distributed across the patient, physician, app, and other resources were contributory.

Linguistic analysis can offer important perspectives on patient experiences. The patient, physician, and decision aid app each played roles as agents during shared decision-making. Attending to various roles of agency in clinical encounters and in educational interventions may help health professionals more effectively conduct shared decision-making.