A pragma-dialectical perspective on obstacles to shared decision-making

2018 ◽  
Vol 7 (2) ◽  
pp. 161-176 ◽  
Author(s):  
Roosmaryn Pilgram ◽  
Francisca Snoeck Henkemans
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Critical Discussion ◽  
Medical Decision ◽  
Shared Decision ◽  
Systematic Account ◽  
Dialectical Theory ◽  
Different Types ◽  
Argumentative Discussion ◽  
Dialectical Perspective

Abstract Shared medical decision-making has been analyzed as a particular kind of argumentative discussion. In the pragma-dialectical argumentation theory, different types of conditions and rules are formulated for the ideal of a reasonable argumentative discussion. In this paper, we shall first show how making use of the distinctions made in the pragma-dialectical theory between different types of conditions for reasonable discussion can help to give a more systematic account of the obstacles that need to be overcome for shared decision-making to be successful. Next, by referring to the rules for critical discussion, we shall provide a more detailed explanation than can be found in the literature on health communication of why certain types of conduct of the participants in the medical encounter can be analyzed as obstacles to the goal of shared decision-making.

scholarly journals Institutional constraints on strategic maneuvering in shared medical decision-making

2012 ◽  
Vol 1 (1) ◽  
pp. 19-32 ◽  
Author(s):  
A. Francisca Snoeck Henkemans ◽  
Dima Mohammed
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Medical Decision Making ◽  
Critical Discussion ◽  
Medical Decision ◽  
Institutional Constraints ◽  
Treatment Preferences ◽  
Shared Decision ◽  
Basic Principles ◽  
The Ideal

In this paper it is first investigated to what extent the institutional goal and basic principles of shared decision making are compatible with the aim and rules for critical discussion. Next, some techniques that doctors may use to present their own treatment preferences strategically in a shared decision making process are discussed and evaluated both from the perspective of the ideal of shared decision making and from that of critical discussion.

scholarly journals Using argumentation theory to identify the challenges of shared decision-making when the doctor and the patient have a difference of opinion

2012 ◽  
Vol 1 (2) ◽  
pp. 26 ◽  
Author(s):  
Claudia A. Zanini ◽  
Sara Rubinelli
Keyword(s):  
Decision Making ◽  
Dispute Resolution ◽  
Shared Decision Making ◽  
Communication Skills ◽  
Critical Discussion ◽  
Argumentation Theory ◽  
Shared Decision ◽  
Ideal Model ◽  
Difference Of Opinion ◽  
The Ideal

This paper aims to identify the challenges in the implementation of shared decision-making (SDM) when the doctor and the patient have a difference of opinion. It analyses the preconditions of the resolution of this difference of opinion by using an analytical and normative framework known in the field of argumentation theory as the ideal model of critical discussion. This analysis highlights the communication skills and attitudes that both doctors and patients must apply in a dispute resolution-oriented communication. Questions arise over the methods of empowerment of doctors and patients in these skills and attitudes as the preconditions of SDM. Overall, the paper highlights aspects in which research is needed to design appropriate programmes of training, education and support in order to equip doctors and patients with the means to successfully engage in shared decision-making.

Prudence in Shared Decision-Making: The Missing Link between the “Technically Correct” and the “Morally Good” in Medical Decision-Making

2020 ◽  
Author(s):  
Paul Muleli Kioko ◽  
Pablo Requena Meana
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Patient Autonomy ◽  
Intellectual Ability ◽  
Medical Decision ◽  
Shared Decision ◽  
Physician Patient Relationship ◽  
Good Healing ◽  
The Right ◽  
Physician Patient

Abstract Shared Decision-Making is a widely accepted model of the physician–patient relationship providing an ethical environment in which physician beneficence and patient autonomy are respected. It acknowledges the moral responsibility of physician and patient by promoting a deliberative collaboration in which their individual expertise—complementary in nature, equal in importance—is emphasized, and personal values and preferences respected. Its goal coincides with Pellegrino and Thomasma’s proximate end of medicine, that is, a technically correct and morally good healing decision for and with a particular patient. We argue that by perfecting the intellectual ability to apprehend the complexity of clinical situations, and through a perfection of the application of the first principles of practical reason, prudence is able to point toward the right and good shared medical decision. A prudent shared medical decision is therefore always in keeping with the kind of person the physician and the patient have chosen to be.

scholarly journals Navigating the Decision Space: Shared Medical Decision Making as Distributed Cognition

2016 ◽  
Vol 27 (7) ◽  
pp. 1035-1048 ◽  
Author(s):  
Katherine D. Lippa ◽  
Markus A. Feufel ◽  
F. Eric Robinson ◽  
Valerie L. Shalin
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Distributed Cognition ◽  
Medical Decision Making ◽  
Medical Training ◽  
Adverse Outcomes ◽  
Medical Decision ◽  
Shared Decision ◽  
Access To Information ◽  
Decision Space

Despite increasing prominence, little is known about the cognitive processes underlying shared decision making. To investigate these processes, we conceptualize shared decision making as a form of distributed cognition. We introduce a Decision Space Model to identify physical and social influences on decision making. Using field observations and interviews, we demonstrate that patients and physicians in both acute and chronic care consider these influences when identifying the need for a decision, searching for decision parameters, making actionable decisions Based on the distribution of access to information and actions, we then identify four related patterns: physician dominated; physician-defined, patient-made; patient-defined, physician-made; and patient-dominated decisions. Results suggests that (a) decision making is necessarily distributed between physicians and patients, (b) differential access to information and action over time requires participants to transform a distributed task into a shared decision, and (c) adverse outcomes may result from failures to integrate physician and patient reasoning. Our analysis unifies disparate findings in the medical decision-making literature and has implications for improving care and medical training.

scholarly journals Development and Evaluation of the Shared Decision Making Process Scale: A Short Patient-Reported Measure

2020 ◽  
pp. 0272989X2097787
Author(s):  
K. D. Valentine ◽  
Ha Vo ◽  
Floyd J. Fowler ◽  
Suzanne Brodney ◽  
Michael J. Barry ◽  
...  
Keyword(s):  
Decision Making ◽  
Construct Validity ◽  
Shared Decision Making ◽  
Small Sample ◽  
Decision Quality ◽  
Medical Decision ◽  
Shared Decision ◽  
Partial Credit ◽  
Patient Reported ◽  
Process Scale

Background The Shared Decision Making (SDM) Process scale is a short patient-reported measure of the amount of SDM that occurs around a medical decision. SDM Process items have been used previously in studies of surgical decision making and exhibited discriminant and construct validity. Method Secondary data analysis was conducted across 8 studies of 11 surgical conditions with 3965 responses. Each study contained SDM Process items that assessed the discussion of options, pros and cons, and preferences. Item wording, content, and number of items varied, as did inclusion of measures assessing decision quality, decisional conflict (SURE scale), and regret. Several approaches for scoring, weighting, and the number of items were compared to identify an optimal approach. Optimal SDM Process scores were compared with measures of decision quality, conflict, and regret to examine construct validity; meta-analysis generated summary results. Results Although all versions of the scale were highly correlated, a short, partial credit, equally weighted version of the scale showed favorable properties. Overall, higher SDM Process scores were related to higher decision quality ( d = 0.18, P = 0.029), higher SURE scale scores ( d = 0.57, P < 0.001), and lower decision regret ( d = −0.34, P < 0.001). Significant heterogeneity was present in all validity analyses. Limitations Included studies all focused on surgical decisions, several had small sample sizes, and many were retrospective. Conclusion SDM Process scores showed resilience to coding changes, and a scheme using the short, partial credit, with equal weights was adopted. The SDM Process scores demonstrated a small, positive relationship with decision quality and were consistently related to lower decision conflict and less regret, providing evidence of validity across several surgical decisions.

scholarly journals Treatment Choice in Adolescents With Cleft Lip and/or Palate: The Importance of Shared Decision-Making

2019 ◽  
Vol 56 (9) ◽  
pp. 1220-1229
Author(s):  
Francesca Wogden ◽  
Alyson Norman ◽  
Louise Dibben
Keyword(s):  
Decision Making ◽  
Young People ◽  
Shared Decision Making ◽  
Cleft Lip ◽  
Well Being ◽  
Medical Decision ◽  
Shared Decision ◽  
Pediatric Dentist ◽  
Semistructured Interviews ◽  
Inductive Thematic Analysis

Objective: Limited research has studied the involvement of children in medical decision-making. The aim of the study was to understand the involvement of adolescents with cleft lip and/or palate (CL/P) in decisions about elective surgeries and treatments. Design: Parents and professionals completed mixed-methods questionnaires about the degree to which children had been involved in choices about elective treatments. Data were analyzed using content analysis. Young people aged 12 to 25 years were asked to take part in semistructured interviews. The data were analyzed using inductive thematic analysis. Setting: Questionnaire data collection took place online, and interview data were collected via messenger or telephone-based interviews. Participants: The study employed 30 participants; 11 young people (3 male, 8 female), 17 parents (13 mothers, 4 fathers), and 5 professionals (2 surgeons, 2 speech and language therapists, and 1 pediatric dentist). Results: Five main themes were identified. These reflected participants feeling that with increasing age should come increased involvement in decision-making and that it was important for adolescents to “have a voice” during decision-making. Parents, peers, and health professionals were identified as influencing decisions. Most adolescents reported overall satisfaction with their involvement in decision-making but sometimes felt “left in the dark” by professionals or under pressure from parents. A desire to improve speech and/or appearance was as an area where adolescents wanted to be more involved in decision-making. Conclusions: Shared decision-making is an important factor for psychological well-being by promoting autonomy and self-esteem among adolescents with CL/P.

Does shared decision making for PSA screening empower patients?

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. e549-e549
Author(s):  
James Austin Talcott ◽  
Maureen Bezuhly ◽  
Gina Aharanoff ◽  
Jessica Herzstein ◽  
Michael P. Osborne ◽  
...  
Keyword(s):  
Decision Making ◽  
Randomized Trial ◽  
Shared Decision Making ◽  
Specific Antigen ◽  
Cluster Randomized Trial ◽  
Educational Interventions ◽  
Medical Decision ◽  
Shared Decision ◽  
Psa Screening ◽  
Screening Guideline

e549 Background: Participant characteristics affect shared decision making. In a randomized trial of physician (MD) educational interventions to improve cancer screening guideline compliance, we studied patient (PT) and MD recall of discussions and how PT characteristics affected recall. Methods: In a cluster-randomized trial of educational supports for MDs, we are enrolling an age- (30-89 years) and sex-stratified sample of 216 PTs who underwent a physical examination at two urban hospitals, 18 for each of 12 primary care MDs. Screening guideline formatting (color-coding) and academic detailing were randomly assigned in a 2x2 design. Immediate post-encounter surveys recorded PT and MD recall of screening discussions. Results: Of the first 174 participants, 92 were men. PTs were diverse (69% white) and well educated (73% college degree). When MDs reported a prostate specific antigen (PSA) screening discussion, 32% of PTs did not, and 26% of MDs disagreed when PTs reported the discussion occurred. Further, when the MD reported recommending screening, 26% of PTs disagreed, and 33% of MDs disagreed when their patients reported a recommendation. Overall, agreement between all PTs and MDs on whether screening was recommended was fair (kappa = 0.29) but there was no agreement for PTs over 70 years (kappa = -0.03). PTs reported more elements of shared decision making than MDs (data not shown). When both PT and MD or the MD alone reported that all elements of shared medical decision making had occurred, agreement on whether screening was recommended improved (kappa = 0.54 and 0.45, respectively). When PTs disagreed with their MD, they more often reported recommending for screening not against (11 vs. 4). Conclusions: In a highly educated, diverse PT population, PTs and MDs surveyed immediately after their encounter often disagreed on whether PSA screening was discussed and recommended. Disagreement was worse with older PT age but improved when both PT and MD or the MD alone reported all shared decision making elements. Clinical trial information: NCT02430948.

scholarly journals Patient autonomy in dental medical decision making – demonstrating the need for shared decision making

2020 ◽  
Author(s):  
Mareike Benecke ◽  
Jürgen Kasper ◽  
Christoph Heesen ◽  
Nina Schäffler ◽  
Daniel Reissmann
Keyword(s):  
Multiple Sclerosis ◽  
Decision Making ◽  
General Practice ◽  
Shared Decision Making ◽  
Treatment Decisions ◽  
Medical Decision ◽  
Shared Decision ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Study Results

Abstract Background: Evidence-based Dentistry (EBD), decision aids, patient preferences and autonomy preferences (AP) play an important role in shared decision making (SDM) and are useful tools in the process of medical and dental decisions as well as in developing of quality criteria for decision making in many fields of health care. However, there aren’t many studies on SDM and AP in the field of dentistry. This study aimed at exploring patients’ autonomy preferences in dentistry in comparison to other medical domains. Methods: As a first step, a consecutive sample of 100 dental patients and 16 dentists was recruited at a university-based prosthodontic clinic to assess and compare patients’ and dentists’ preferences regarding their roles in dental decision making for commonly performed diagnostic and treatment decisions using the Control Preference Scale (CPS). This was followed by a cross sectional survey to study autonomy preferences in three cohorts of 100 patients each recruited from general practices, a multiple sclerosis clinic, and a university-based prosthodontic clinic . A questionnaire with combined items from the Autonomy Preference Index (API) to assess general and the CPS to assess specific preferences was used in this process. Results: Dentists were slightly less willing to deliver control than patients willing to enact autonomy. Decisions about management of tooth loss were however considered relevant for a shared decision making by both parties. Highest AP was expressed by people with multiple sclerosis, lowest by patients in dentistry (CPS means: dentistry 2.5, multiple sclerosis 2.1, general practice 2.4, p=.035). Patients analysis showed considerable differences in autonomy preferences referring to different decision types (p<.001). More autonomy was needed for treatment decisions in comparison to diagnostic decisions, for trivial compared to severe conditions, and for dental care compared to general practice (all: p<.001). Conclusion: The study results showed substantial relevance of patient participation in decision making in dentistry. Furthermore, a need has been discovered to refer to specific medical decisions instead of assessing autonomy preferences in general.

scholarly journals What does shared decision making look like in natural settings? A mixed methods study of patient–provider conversations

2018 ◽  
Vol 14 (3) ◽  
pp. 217-228
Author(s):  
Joy Lee ◽  
Wynne Callon ◽  
Carlton Haywood, Jr. ◽  
Sophie M. Lanzkron ◽  
Pål Gulbrandsen ◽  
...  
Keyword(s):  
Decision Making ◽  
Mixed Methods ◽  
Shared Decision Making ◽  
Decision Aids ◽  
Medical Decision ◽  
Shared Decision ◽  
Clinical Issue ◽  
Patient Questionnaires ◽  
Pros And Cons ◽  
Natural Settings

Objective: To understand the variability and nature of shared decision making (SDM) regarding a uniform type of serious medical decision, and to make normative judgments about how these conversations might be improved. Methods: This was a mixed-methods sub-analysis of the Improving Patient Outcomes with Respect and Trust (IMPORT) study. We used the Braddock framework to identify and describe seven elements of SDM in audio-recorded encounters regarding initiation of hydroxyurea, and used data from medical records and patient questionnaires to understand whether and how these tasks were achieved. Results: Physicians covered a spectrum of SDM behaviors: all dialogues contained discussion regarding the clinical issue and the pros and cons of treatment; the patient's understanding and role were not explicitly assessed or stated in any encounter. Yet no patient agreed to start hydroxyurea who did not already prefer it. There was no uniform approach to how physicians presented risk; many concerns expressed by patients in a pre-visit questionnaire were not discussed. Conclusion: In this analysis, patients seemed to understand their role in the decision-making process, suggesting that a patient's role may not always need to be explicitly stated. However, shared decision making might be improved with more routine assessment of patient understanding and concerns. Standardized decision aids might help fully inform patients of risks and benefits.

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