Abstract
BackgroundProven benefits of Shared Decision Making (SDM) include improved patient knowledge, involvement and confidence in making decisions. Although widely advocated in policy, SDM is still not widely implemented in practice. A common patient‐reported barrier is feeling that “doctor knows best”; thus, patients often defer decisions to the clinician.ObjectiveTo examine the nature of the discourse when patients ask clinicians for a treatment recommendation during consultations when treatment decisions are being shared and to examine clinicians’ strategies used in response.Design, Setting and ParticipantsTheme‐orientated discourse analysis was performed on eight audio‐recordings of breast cancer diagnostic consultations in which patients or their partners attempted to defer treatment decisions to the clinician. Clinicians were trained in SDM.ResultsTension was evident in a number of consultations when treatment recommendations were requested. Clinicians responded to recommendation requests by explaining why the decision was being shared (personal nature of the decision, individual preferences and equivalent survival outcomes of treatment options). There was only one instance where a clinician gave a treatment recommendation.Discussion and ConclusionsStrategies for clinicians to facilitate SDM when patients seem to defer decisional responsibility include being clear about why the decision is being shared, acknowledging that this is difficult and making patients feel supported. When patients seek guidance, clinicians can provide a recommendation if grounded in an understanding of the patient's values.
Highlights
Proven benefits of Shared Decision Making (SDM) include improved patient knowledge, involvement and confidence in making decisions
SDM is widely advocated in policy,[5,6] it is still not routinely implemented in practice
Clinicians may be unaware of SDM, sceptical about its value, or lack the confidence and skills to incorporate SDM into their routine practice
Summary
A key element of person‐centred care is shared decision making (SDM), in which patients and clinicians work together to make informed treatment decisions by integrating evidence and patient preferences.[1,2] There is evidence that SDM improves patient knowledge, involvement and confidence in making decisions,[3] as well as adherence to recommended care.[4]. This is unsurprising given the complexities of sharing decisions, in the emotionally charged context of cancer treatment when decisions have major consequences for patients and their families Both patients and clinicians undertook remedial work during the consultations to repair these moments of tension.[27] That said, our study corroborates previous research findings[31] that, with the right communication attitudes, skills and tools, clinicians can enable SDM conversations to continue, even when patients seek a treatment recommendation
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