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Multicenter Study
. 2018 Aug;101(8):1368-1377.
doi: 10.1016/j.pec.2018.03.014. Epub 2018 Mar 11.

An expanded framework to define and measure shared decision-making in dialogue: A 'top-down' and 'bottom-up' approach

Wynne Callon  1 , Mary Catherine Beach  2 , Anne R Links  1 , Carly Wasserman  1 , Emily F Boss  1
Affiliations
Multicenter Study

An expanded framework to define and measure shared decision-making in dialogue: A 'top-down' and 'bottom-up' approach

Wynne Callon et al. Patient Educ Couns. 2018 Aug.

Abstract

Objectives: We aimed to develop a comprehensive, descriptive framework to measure shared decision making (SDM) in clinical encounters.

Methods: We combined a top-down (theoretical) approach with a bottom-up approach based on audio-recorded dialogue to identify all communication processes related to decision making. We coded 55 pediatric otolaryngology visits using the framework and report interrater reliability.

Results: We identified 14 clinician behaviors and 5 patient behaviors that have not been previously described, and developed a new SDM framework that is descriptive (what does happen) rather than normative (what should happen). Through the bottom-up approach we identified three broad domains not present in other SDM frameworks: socioemotional support, understandability of clinician dialogue, and recommendation-giving. We also specify the ways in which decision-making roles are assumed implicitly rather than discussed explicitly. Interrater reliability was >75% for 92% of the coded behaviors.

Conclusion/practice implications: This SDM framework allows for a more expansive understanding and analysis of how decision making takes place in clinical encounters, including new domains and behaviors not present in existing measures. We hope that this new framework will bring attention to a broader conception of SDM and allow researchers to further explore the new domains and behaviors identified.

Keywords: Conversation analysis; Pediatrics; SDM framework; Shared decision-making; Tonsillectomy.

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Conflict of interest statement

None of the authors have any relevant financial conflicts of interest.

Comment in

  • On how to define and measure SDM.
    Pieterse AH, Bomhof-Roordink H, Stiggelbout AM. Pieterse AH, et al. Patient Educ Couns. 2018 Aug;101(8):1307-1309. doi: 10.1016/j.pec.2018.06.001. Patient Educ Couns. 2018. PMID: 29937154 No abstract available.

References

    1. Einstein A On the Method of Theoretical Physics (Oxford University Press, 1933).
    1. Elwyn G, Edwards A, Kinnersley P & Grol R Shared decision making and the concept of equipoise: the competences of involving patients in healthcare choices. Br J Gen Pr 50, 892–899 (2000). - PMC - PubMed
    1. Barry MJ & Edgman-Levitan S Shared Decision Making — The Pinnacle of Patient-Centered Care. N. Engl. J. Med 366, 780–781 (2012). - PubMed
    1. Keirns CC & Goold SD Patient-Centered Care and Preference-Sensitive Decision Making. JAMA 302, 1805–1806 (2009). - PubMed
    1. Elwyn G et al. Shared decision making: a model for clinical practice. J. Gen. Intern. Med 27, 1361–1367 (2012). - PMC - PubMed

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