Communication practices that encourage and constrain shared decision-making in healthcare encounters: systematic review of conversation analytic research

Land, Victoria and Parry, Ruth and Seymour, Jane Communication practices that encourage and constrain shared decision-making in healthcare encounters: systematic review of conversation analytic research. Health Expectations . ISSN 1369-7625 (In Press)

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Abstract

Background

Shared decision-making (SDM) is generally treated as good practice in healthcare interactions. Conversation analytic research has yielded detailed findings about decision-making in healthcare encounters.

Objective

To map decision-making communication practices relevant to healthcare outcomes in face-to-face interactions yielded by prior conversation analyses, and to examine their function in relation to SDM.

Search strategy

We searched nine electronic databases (last search November 2016) and our own and other academics’ collections.

Inclusion criteria

Published conversation analyses (no restriction on publication dates) using recordings of healthcare encounters in English where the patient (and/or companion) was present and where the data and analysis focused on health/illness-related decision-making.

Data extraction and synthesis

We extracted study characteristics, aims, findings relating to communication practices, how these functioned in relation to SDM, and internal/external validity issues. We synthesised findings aggregatively.

Results

Twenty-eight publications met the inclusion criteria. We sorted findings into 13 types of communication practices and organised these in relation to four elements of decision-making sequences: (1) broaching decision-making; (2) putting forward a course of action; (3) committing or not (to the action put forward); and (4) HCPs’ responses to patients’ resistance or withholding of commitment. Patients have limited opportunities to influence decision-making. HCPs’ practices may constrain or encourage this participation.

Conclusions

Patients, companions and HCPs together treat and undertake decision-making as shared, though to varying degrees. Even for non-negotiable treatment trajectories, the spirit of SDM can be invoked through practices that encourage participation (e.g. by bringing the patient towards shared understanding of the decision’s rationale).

Item Type: Article
Keywords: Conversation analysis; shared decision-making; patient participation; patient choice; medical interaction; systematic review
Schools/Departments: University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Health Sciences
Depositing User: Eprints, Support
Date Deposited: 04 May 2017 12:42
Last Modified: 05 May 2017 16:09
URI: http://eprints.nottingham.ac.uk/id/eprint/42525

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