An expanded framework to define and measure shared decision-making in dialogue: A ‘top-down’ and ‘bottom-up’ approach

Callon, Wynne; Beach, Mary Catherine; Links, Anne R.; Wasserman, Carly; Boss, Emily F.

doi:10.1016/j.pec.2018.03.014

Cited by 35 publications

(33 citation statements)

References 26 publications

(28 reference statements)

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“…However, our approach demands more of research than just a focus on patients’ propositions. For areas of clinical practice that need to be both empirically informed and ethically justified, “top‐down,” deductive research needs to be balanced by inductive “bottom‐up” research; that is, by careful analysis of the ways in which practitioners and patients navigate the demands, constraints and opportunities of specific settings . Such research exposes practices to researchers, theorists, practitioners and educators, who can examine and critique them from different theoretical and ethical perspectives.…”

Section: Discussionmentioning

confidence: 99%

Reconciling the theory and reality of shared decision‐making: A “matching” approach to practitioner leadership

Brown

Salmon

2018

Health Expectations

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Shared decision making (SDM) evolved to resolve tension between patients’ entitlement to make health‐care decisions and practitioners’ responsibility to protect patients’ interests. Implicitly assuming that patients are willing and able to make “good” decisions, SDM proponents suggest that patients and practitioners negotiate decisions. In practice, patients often do not wish to participate in decisions, or cannot make good decisions. Consequently, practitioners sometimes lead decision making, but doing so risks the paternalism that SDM is intended to avoid. We argue that practitioners should take leadership when patients cannot make good decisions, but practitioners will need to know: (a) when good decisions are not being made; and (b) how to intervene appropriately and proportionately when patients cannot make good decisions. Regarding (a), patients rarely make decisions using formal decision logic, but rely on informal propositions about risks and benefits. As propositions are idiographic and their meanings context‐dependent, normative standards of decision quality cannot be imposed. Practitioners must assess decision quality by making subjective and contextualized judgements as to the “reasonableness” of the underlying propositions. Regarding (b), matched to judgements of reasonableness, we describe levels of leadership distinguished according to how directively practitioners act; ranging from prompting patients to question unreasonable propositions or consider new propositions, to directive leadership whereby practitioners recommend options or deny requested procedures. In the context of ideas of relational autonomy, the objective of practitioner leadership is to protect patients’ autonomy by supporting good decision making, taking leadership in patients’ interests only when patients are unwilling or unable to make good decisions.

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Section: Discussionmentioning

confidence: 99%

Reconciling the theory and reality of shared decision‐making: A “matching” approach to practitioner leadership

Brown

Salmon

2018

Health Expectations

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“…Our research directly evaluating live patient consultations indicates that parents express concerns in <40% of encounters, and that clinicians rarely directly ask about parent concerns or fears during consultations for tonsillectomy. 30 Moreover clinicians may neglect to discuss aspects of surgery important to parents, such as anesthesia, and have a tendency towards authoritativeness 36,37 . Research has demonstrated communication pitfalls, such as clinician tendencies to be verbally dominant, ask few open-ended questions, and often neglect to respond to patient fears with direct empathy 38,39 .…”

Section: Discussionmentioning

confidence: 99%

“…However, parent concerns are often not shared with, or made clear to, the clinician during surgical consultation. 11 Posts about tonsillectomy on social media outlets provide insight into parental perspectives that may not be expressed to clinicians or researchers. Such social media sources may assist in evaluating patient-centered outcomes related to health care.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Parental Perspectives and Concerns About Pediatric Tonsillectomy in Social Media

Hairston

Links

Harris

et al. 2019

JAMA Otolaryngol Head Neck Surg

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Importance: Tonsillectomy is common in children, but little is known about parental preferences and values concerning this surgery. Social media offers a novel opportunity to evaluate parent understanding and experience of care. Objective: We systematically evaluate posts in a well-known social media site to identify parent perspectives about tonsillectomy in children that may not be apparent in a routine clinical encounter. Design: In this mixed methods analysis, we searched Twitter© for posts (“tweets”) from 2008-2017 written by parents about their child’s tonsillectomy. We applied modified grounded theory to develop a coding taxonomy to classify these tweets. Two reviewers assessed tweets for thematic synthesis and classification. Tweets were quantified, and descriptive statistics were obtained for each theme. Setting: The posts on the social media site www.twitter.com. Participants: A sample of over 700 adult American parents of children who received or will receive a tonsillectomy and posted on Twitter. Main Outcomes and Measures: Themes of parent experiences and perspectives about their child’s tonsillectomy. Results: Of 5801 tweets retrieved, 782 satisfied our inclusion criteria. Tweets fell into overarching themes of 1. procedural concerns (n=549, 70.2%) and 2. attitudes/experiences (n=498, 63.7%). Common tweets related to procedural concerns regarded surgical indication (“sick for months”; n=55,7.0%), recovery [n=227, 29.0%; including child’s attitude (“she is nervous”; n=89, 11.4%) nutrition (“won’t eat”; n=89, 11.4%), and parental experience (“harder on the parents than the kid”;(n=87, 11.1%))]. Common tweets regarding attitudes/experiences included tenor of overall care (“yay for tonsil surgery!”; n=155, 19.8%), and fears/apprehensions (“frankly, I’m terrified”; n=178, 22.8%). Conclusions and Relevance: This analysis provides insight into parent perspectives on pediatric tonsillectomy. Parents commonly tweet concerns about surgery that may not be recognized in routine clinician-parent dialogue. Findings may be used to guide clinicians in educating and counseling parents, and further engaging parents and children in shared decision-making for tonsillectomy.

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“…5 More recent models of "true" shared decision-making include additional potential domains, including socioemotional support, understandability of clinician dialogue, and recommendation giving. 6 CMS focused on Option Talk, presumably because Option and Decision Talk are harder to document and providing as much information as possible makes common sense. They require that multiple facts regarding the harms and benefits be presented to patients during an in-person shared decision-making visit.…”

Section: Patient-centered Communication and Shared Decision-makingmentioning

confidence: 99%

COUNTERPOINT: Can Shared Decision-Making of Physicians and Patients Improve Outcomes in Lung Cancer Screening? No

Slatore

2019

Chest

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An expanded framework to define and measure shared decision-making in dialogue: A ‘top-down’ and ‘bottom-up’ approach

Cited by 35 publications

References 26 publications

Reconciling the theory and reality of shared decision‐making: A “matching” approach to practitioner leadership

Reconciling the theory and reality of shared decision‐making: A “matching” approach to practitioner leadership

Evaluation of Parental Perspectives and Concerns About Pediatric Tonsillectomy in Social Media

COUNTERPOINT: Can Shared Decision-Making of Physicians and Patients Improve Outcomes in Lung Cancer Screening? No

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