Purifying and hybridising categories in healthcare decision-making: the clinic, the home and the multidisciplinary team meeting

Abstract

This article explores processes of legitimising health knowledge in three different spaces: the clinic, the home and the multidisciplinary meeting. It considers the ways in which categorisation work, health understandings and therapeutic actions are intertwined. The analysis draws on ethnomethodology and actor-network theory to suggest that in the clinic consultation room, a number of interactional elements in talk about side effects and talk about unorthodox interventions attempt to stabilise the categories used by health experts. In contrast, the household is a centre of knowledge production that may subvert, manipulate or align with expert systems. Fixed and stable expert knowledge becomes flexible and hybridised inside the home. In the multidisciplinary team meeting different forms of authority are called upon in hospital-based cancer care meetings, where health professionals mix scientific understandings with other ways of knowing in determining treatment options. From these empirical observations it is argued that therapeutic actions are not subject in any simplistic way to a dominant mode of understanding, but there are many means of understanding that selectively come into play in relation to the specifics of the interaction that is occurring between patients, health professionals and therapeutic spaces. ARTICLE HISTORY

How multidisciplinary are multidisciplinary case reviews in cancer care? Feasibility analysis of a theory-driven team decision-making fidelity framework

“…In terms of the degree to which the teams adhered to the ODDI-defined stages of group decisionmaking, we found that although all patients in the study were consistently reviewed by a MDT, as mandated by national policy in the UK, the orientation stage (i.e., case presentation) was bypassed in 4% of the cases as the team went straight into discussing the patient, and for 8% of the cases the decision was not clearly stated upon completion of the team's deliberation. This is in line with previous research reporting that decisions are not always being explicitly stated in MDT meetings [35], and that when time pressures exist, the orientation stage is most frequently compromised [31].…”

“…(1) audio quality and clarity for transcription using complex notation system [34] in a corpora comprising multiple speakers adding further to the complexity of the transcription (this was also the criteria in Dew et al, 2014 study on cancer teams) [35];…”

Black and Minority Ethnic women's decision-making for risk reduction strategies after BRCA testing: Use of context and knowledge

“…Results are interesting in their similarity to non-BME focused studies, suggesting that the systems and processes patients use to make M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 23 decisions are likely to be more similar than researchers and clinicians sometimes acknowledge. It is important to recognise that not all women rejected or accepted interventions outright, based on medical opinion alone, but that as Busby et al (1997), Dew (2016) and Willis et al (2016) have highlighted, women created specific and functional forms of social knowledge to help them make sense of their clinical situations and construct rational motives for their decisions around risk reduction strategies. Helping clinicians understand those rational motives will be useful in helping women engage deeper in discussions around future health maximising.…”

“…The various reasons that women have to consider are invariably a mix of clinician advice and experiences of cancers within the family, to name a few (Lifford et al, 2013). In fact, Dew (2016) shows that decisions for health, and how people understand various health related concerns are played out in many locations, and not just the clinic, as shown by the narratives and reasons given by these women. As such, our participants, in deciding on risk reduction strategies, evaluate their concerns using information gathered from their clinical consultations but placed within the context of their homes and social environments.…”

Tieto, valta ja vastuu erityislasten hoidossa

“…(Esim. Koivikko & Sipari 2006, 36-37;Dew 2016. ) Erityisterveydenhuollon ammattilaisten tieto on usein syvällistä mutta kapea-alaista.…”