Towards Patient-Centeredness? Media Frames on Shared Decision-Making for Healthcare Treatment

Abstract

The literature on healthcare management and innovation has long noted that shared decision-making (SDM), a practice of organizing joint decisions between healthcare professionals and patients, should improve healthcare outcomes by increasing patient engagement and autonomy, and thus fostering patient-centeredness and equality. While SDM projects are increasingly implemented across Europe and worldwide, the diffusion of the practice remains partial. The healthcare management and innovation literature explores SDM trough the underlying assumption that its diffusion constraints result from an information problem, implying objective criteria and rational behavior. The purpose of this research is to conduct a study on the social construction of SDM and underlying rationales using the case of one of the largest healthcare markets worldwide – Germany. To capture the complexity of SDM, a frame analysis is conducted on its medial representations. Media are both influential in shaping public opinion as well as generating public discourses This enables to elaborate the different facets of the construct, to capture inherent patterns and to explore the consequences for the acceptance and diffusion of SDM in Germany. Three facilitating and three obstructive frames were assessed. The polarities of these findings range from the questioning of one's own decision-making authority to the perception of individual competence and decision-making agency. Moreover, this study reflects on how physicians’ and patients’ role for SDM is conceived. Regarding physicians these alternate between the perception of the ‘demigod in white’ and the loss of decision-making authority. Regarding the patients these alternate between the perception of the ‘layman’ and the competent patient, eager to participate in decision-making.