Understanding relational aspects of shared decision-making in gynaecology: A qualitative analysis of patients’ and physicians’ perspectives as well as clinical consultations

Abstract

Rationale, aims and objectives: Following increased interest in the complexity of relational aspects of shared decision-making (SDM), this study traces the meanings and practices of the ways decisions are shared in clinical encounters within gynaecology. Methods: Guided by grounded theory, we analysed semi-structured interviews with 18 patients and 11 physicians as well as 33 observed consultations from 6 gynaecological outpatient care settings, selected by maximum variety sampling in the Basel area of Switzerland. Results: The results show how clinicians and patients co-produce different meanings and practices regarding decision-making across various care settings. Although female and male clinicians equally engaged in reciprocal bonds with patients in the decision-making process, the nature of these bonds differed and patients attributed gendered and different emotional meanings to decision-making. Shared decision-making was only advocated in female physician/female patient constellations, grounded in ‘being in reciprocal exchange’ due to sameness in gender and displayed as a means for creating closeness, empathy and support. In male physician/female patient constellations, the reciprocal bond was constructed upon unequal distribution of medical knowledge with patients favouring direct medical advice. However, whether patients felt supported in decision-making processes rather seemed to depend upon the continuity of clinical relationships than on the decision-making practices or care setting. Conclusion: By integrating different perspectives, insights into the complexity of relational aspects of SDM in gynaecology were obtained. Emotional meanings and practices of SDM differ according to gender constellations, care settings and continuity of clinical relationships.