scholarly journals “I am in other people's hands as regards my health” A sociological critique of health care encounters of people with cirrhosis. A secondary analysis

2021 ◽  
pp. 174239532110584
Author(s):  
Sarah Davis ◽  
Paul Higgs ◽  
Louise Jones ◽  
Lynda Greenslade ◽  
Jo Wilson ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Secondary Analysis ◽  
Medical Knowledge ◽  
Shared Decision ◽  
Structured Interviews ◽  
Clinical Encounters ◽  
Key Concepts ◽  
The Face ◽  
Health Care Encounters

Objectives People with cirrhosis are encouraged to participate in shared decision-making with their doctors, but studies suggest that doctors limit the amount of information that is shared. In this study we explore the presence of medical power in clinical encounters in 2015 from a patient perspective and highlight its effects on healthcare interactions. Methods Qualitative semi-structured interviews were conducted with ten people with cirrhosis attending a tertiary liver transplant centre in southern England. We explored their understanding of their disease and prognosis, and their participation in decision-making. Using the lens of medical power as a framework, we analysed findings into thematic sentences to summarise key ideas whilst preserving the complexity of identified concepts. Results Three key concepts explained patient perspectives of their communication with doctors: (1) portraying a positive image to doctors, (2) avoiding confrontation with doctors, (3) feeling powerless in the face of doctors’ medical knowledge. These concepts show deeper dynamic issues of power during healthcare encounters, illustrated by participants’ reluctance to voice their concerns and express themselves, challenge decisions, or seek information. Conclusion People with cirrhosis struggle to articulate their concerns or challenge decisions on their care and treatment and may worry about potential consequences. Our findings demonstrate the continuing persistence of issues of power at play in contemporary health care.

Understanding relational aspects of shared decision-making in gynaecology: A qualitative analysis of patients’ and physicians’ perspectives as well as clinical consultations

2015 ◽  
Vol 3 (4) ◽  
pp. 456
Author(s):  
Bettina Schwind ◽  
Karin Gross ◽  
Nina Wehner ◽  
Beate Wegener ◽  
Sibil Tschudin ◽  
...  
Keyword(s):  
Decision Making ◽  
Female Patient ◽  
Shared Decision Making ◽  
Medical Knowledge ◽  
Female Physician ◽  
Shared Decision ◽  
Structured Interviews ◽  
Male Physician ◽  
Unequal Distribution ◽  
Clinical Encounters

Rationale, aims and objectives: Following increased interest in the complexity of relational aspects of shared decision-making (SDM), this study traces the meanings and practices of the ways decisions are shared in clinical encounters within gynaecology. Methods: Guided by grounded theory, we analysed semi-structured interviews with 18 patients and 11 physicians as well as 33 observed consultations from 6 gynaecological outpatient care settings, selected by maximum variety sampling in the Basel area of Switzerland. Results: The results show how clinicians and patients co-produce different meanings and practices regarding decision-making across various care settings. Although female and male clinicians equally engaged in reciprocal bonds with patients in the decision-making process, the nature of these bonds differed and patients attributed gendered and different emotional meanings to decision-making. Shared decision-making was only advocated in female physician/female patient constellations, grounded in ‘being in reciprocal exchange’ due to sameness in gender and displayed as a means for creating closeness, empathy and support. In male physician/female patient constellations, the reciprocal bond was constructed upon unequal distribution of medical knowledge with patients favouring direct medical advice. However, whether patients felt supported in decision-making processes rather seemed to depend upon the continuity of clinical relationships than on the decision-making practices or care setting. Conclusion: By integrating different perspectives, insights into the complexity of relational aspects of SDM in gynaecology were obtained. Emotional meanings and practices of SDM differ according to gender constellations, care settings and continuity of clinical relationships.

Understanding the Role of Past Health Care Discrimination in Help-Seeking and Shared Decision-Making for Depression Treatment Preferences

2020 ◽  
Vol 30 (12) ◽  
pp. 1833-1850
Author(s):  
Ana M. Progovac ◽  
Dharma E. Cortés ◽  
Valeria Chambers ◽  
Jonathan Delman ◽  
Deborah Delman ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Help Seeking ◽  
Treatment Modalities ◽  
Treatment Preferences ◽  
Depression Treatment ◽  
Shared Decision ◽  
Structured Interviews

As a part of a larger, mixed-methods research study, we conducted semi-structured interviews with 21 adults with depressive symptoms to understand the role that past health care discrimination plays in shaping help-seeking for depression treatment and receiving preferred treatment modalities. We recruited to achieve heterogeneity of racial/ethnic backgrounds and history of health care discrimination in our participant sample. Participants were Hispanic/Latino ( n = 4), non-Hispanic/Latino Black ( n = 8), or non-Hispanic/Latino White ( n = 9). Twelve reported health care discrimination due to race/ethnicity, language, perceived social class, and/or mental health diagnosis. Health care discrimination exacerbated barriers to initiating and continuing depression treatment among patients from diverse backgrounds or with stigmatized mental health conditions. Treatment preferences emerged as fluid and shaped by shared decisions made within a trustworthy patient–provider relationship. However, patients who had experienced health care discrimination faced greater challenges to forming trusting relationships with providers and thus engaging in shared decision-making processes.

scholarly journals Who knows best? Negotiations of knowledge in clinical decision making

2015 ◽  
Author(s):  
Charlotte Bredahl Jacobsen ◽  
Helle Max Martin ◽  
Vibe Hjelholt Baker
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Health Professionals ◽  
Patient Involvement ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Shared Decision ◽  
Structured Interviews ◽  
Knowledge Domains ◽  
Clinical Encounters

 This article examines the conflicts which arise when patients with chronic disease engage in decision making with health professionals about their medication. These are conflicts in the sense of discrepancies or incompatibilities between perceptions or opinions of different people engaged in a common endeavour. The paper is based on three qualitative research studies and presents one case from each study to illustrate analytical findings. Data collected in the original studies consisted of observations of clinical encounters and semi-structured interviews; in total 45 interviews with patients and 23 with health professionals. The analysis shows different conflicts, which arise during the process of making decisions about medication. These conflicts arise when: 1) Patients deliberately hold back information about their medication for fear of challenging clinicians’ authority; 2) The decision making process takes place in an environment, which does not support patient involvement; and 3) Patients refer to pharmacological knowledge, but are considered ill-equipped to understand and apply this knowledge by health professionals. The article shows that these conflicts typically revolve around the legitimate access to and use of pharmacological knowledge. These results have important implications for the current discussions of shared decision making. In shared decision making, knowledge about medication is typically regarded as the domain of the doctor. We argue that there is a need for a widening of the concept of partnership, which is central to shared decision making, to encompass breadth of patient knowledge about his/her situation, disease and treatment. Patients with chronic diseases need to be actively invited to disclose the extensive clinical knowledge they acquire over time, thereby creating a legitimate space for this knowledge in clinical consultations, and avoiding that conflicts over knowledge domains lead to unnecessary suffering and wasted resources.

scholarly journals Development of an electronic conversation aid to support shared decision making for children with acute otitis media

JAMIA Open ◽  
2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Jana L Anderson ◽  
e Silva Lucas Oliveira J ◽  
Juan P Brito ◽  
Ian G Hargraves ◽  
Erik P Hess
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Otitis Media ◽  
Acute Otitis Media ◽  
Medical Knowledge ◽  
Complication Rates ◽  
Shared Decision ◽  
Web Based ◽  
Quality Issue ◽  
The Impact

Abstract Objective The overuse of antibiotics for acute otitis media (AOM) in children is a healthcare quality issue in part arising from conflicting parent and physician understanding of the risks and benefits of antibiotics for AOM. Our objective was to develop a conversation aid that supports shared decision making (SDM) with parents of children who are diagnosed with non-severe AOM in the acute care setting. Materials and Methods We developed a web-based encounter tool following a human-centered design approach that includes active collaboration with parents, clinicians, and designers using literature review, observations of clinical encounters, parental and clinician surveys, and interviews. Insights from these processes informed the iterative creation of prototypes that were reviewed and field-tested in patient encounters. Results The ear pain conversation aid includes five sections: (1) A home page that opens the discussion on the etiologies of AOM; (2) the various options available for AOM management; (3) a pictograph of the impact of antibiotic therapy on pain control; (4) a pictograph of complication rates with and without antibiotics; and (5) a summary page on management choices. This open-access, web-based tool is located at www.earpaindecisionaid.org. Conclusions We collaboratively developed an evidence-based conversation aid to facilitate SDM for AOM. This decision aid has the potential to improve parental medical knowledge of AOM, physician/parent communication, and possibly decrease the overuse of antibiotics for this condition.

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