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Communication practices that encourage and constrain shared decision making in health-care encounters: Systematic review of conversation analytic research

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JournalHealth expectations : an international journal of public participation in health care and health policy
DateAccepted/In press - 17 Feb 2017
DateE-pub ahead of print - 18 May 2017
DatePublished (current) - 16 Nov 2017
Issue number6
Volume20
Number of pages20
Pages (from-to)1228–1247
Early online date18/05/17
Original languageEnglish

Abstract

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

Objective
To map decision making communication practices relevant to health-care 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 health-care 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 organized these in relation to four elements of decision-making sequences: (i) broaching decision making; (ii) putting forward a course of action; (iii) committing or not (to the action put forward); and (iv) 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 (eg by bringing the patient towards shared understanding of the decision's rationale).

Bibliographical note

© 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd

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