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Observational Study
. 2024 May 16;14(5):e079540.
doi: 10.1136/bmjopen-2023-079540.

Explorative observational study of Dutch patient-clinician interactions: operationalisation of personal perspective elicitation as part of shared decision-making in real-life audio-recorded consultations

Ester A Rake  1   2 , Marjan J Meinders  3 , Guus Brand  3 , Dunja Dreesens  2 , Jan A M Kremer  3 , Glyn Elwyn  3   4 , Johanna W M Aarts  5
Affiliations
Observational Study

Explorative observational study of Dutch patient-clinician interactions: operationalisation of personal perspective elicitation as part of shared decision-making in real-life audio-recorded consultations

Ester A Rake et al. BMJ Open. .

Abstract

Objectives: Patients' preferences, values and contexts are important elements of the shared decision-making (SDM) process. We captured those elements into the concept of 'personal perspective elicitation' (PPE), which reflects the need to elicit patients' preferences, values and contexts in patient-clinician conversations. We defined PPE as: 'the disclosure (either elicited by the clinician or spontaneously expressed by the patient) of information related to the patient's personal preferences, values and/or contexts potentially relevant to decision-making'. Our goal was to operationalise the concept of PPE through the evaluation of preferences, values and contexts and explore how PPE occurs in clinical encounters.

Design: Cross-sectional study: observational coding based on a novel coding scheme of audio-recorded outpatient clinical encounters where encounter patient decision aids were applied.

Setting: We audio-recorded patient-clinician interactions at three Dutch outpatient clinics. PPE was analysed using a novel observational coding scheme, distinguishing preferences, contexts and four Armstrong taxonomy value types (global, decisional, external and situational). We measured SDM using the Observer OPTION5.

Participants: Twenty patients who suffered from psoriasis or ovarian cysts; four clinicians.

Results: We included 20 audio-recordings. The mean Observer OPTION5 score was 57.5 (SD:10.1). The audio-recordings gave a rich illustration of preferences, values and contexts that were discussed in the patient-clinician interactions. Examples of identified global values: appearance, beliefs, personality traits. Decisional values were related to the process of decision-making. External values related to asking advice from for example, the clinician or significant others. An identified situational value: a new job ahead. Contexts related to how the illness impacted the life (eg, sexuality, family, sports, work life) of patients.

Conclusions: The operationalisation of PPE, an important aspect of SDM, explores which preferences, values and contexts were discussed during patient-clinician interactions where an ePDA was used. The coding scheme appeared feasible to apply but needs further refinement.

Keywords: Decision Making; Patient-Centered Care; Quality in health care.

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Conflict of interest statement

Competing interests: GE has edited and published books that provide royalties: Shared Decision Making (Oxford University Press) and Groups (Radcliffe Press). Glyn Elwyn’s academic interests are focused on shared decision-making and coproduction. He owns copyright in measures of shared decision-making (collaboRATE) and care integration (integRATE), a measure of experience of care in serious illness (consideRATE), a measure of goal setting coopeRATE, a measure of clinician willingness to do shared decision-making (incorpoRATE), an observer measures of shared decision-making (Observer OPTION-5 and Observer OPTION-12). He is the Founder and Director of &think LLC which owns the registered trademark for Option GridsTM patient decision aids; Founder, Director of SHARPNETWORK LLC, a provider of online training for shared decision-making, consultant to EBSCO Health and Chief Clinical Research Scientist to abridge AI Inc. JAMK is Special Envoy for Appropriate Care (Ministry of Health, the Netherlands). DD is a member of the programme committee of ZonMw. ZonMw programmes and funds research and innovation in health, healthcare and well-being, encourages the use of this knowledge and highlights knowledge needs. JWMA, Guus Brand, Marjan Meinders and Ester Rake: none declared.

Figures

Figure 1
Figure 1
Overview of the observational coding process for elicitations (PPE) and disclosures (PPD) of personal perspectives. Blue boxes depict clinician’s utterances, purple boxes depict patient’s utterances. PPE-C, personal perspective elicitation (PPE) by clinician; PPE-PR, PPE patient’s response; PPE-CR, PPE clinician’s response; PPD-P, personal perspective disclosure—patient; PPD-CR, personal perspective disclosure—clinician’s response.
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