Natalie Joseph-Williams1, Denitza Williams2, Fiona Wood2, Amy Lloyd3, Katherine Brain2, Nerys Thomas4, Alison Prichard4, Annwen Goodland4, Helen McGarrigle5, Helen Sweetland5, Adrian Edwards2. 1. Cardiff University, College of Biomedical and Life Sciences, School of Medicine, Division of Population Medicine, Cardiff, UK. Electronic address: josephnj1@cardiff.ac.uk. 2. Cardiff University, College of Biomedical and Life Sciences, School of Medicine, Division of Population Medicine, Cardiff, UK. 3. Cardiff University, College of Biomedical and Life Sciences, Centre for Trials Research, Cardiff, UK. 4. Pre dialysis Team, Cardiff and Vale University Health Board, Nephrology and Transplant Directorate, University Hospital of Wales, Cardiff, UK. 5. Cardiff Breast Centre, Cardiff and Vale University Health Board, University Hospital Llandough, Cardiff, UK.
Abstract
OBJECTIVE: Research is needed to understand how Shared Decision-Making (SDM) is enacted in routine clinical settings. We aimed to 1) describe the process of SDM between clinicians and patients; 2) examine how well the SDM process compares to a prescriptive model of SDM, and 3) propose a descriptive model based on observed SDM in routine practice. METHODS: Patients with chronic kidney disease and early stage breast cancer were recruited consecutively via Cardiff and Vale University Health Board (UK) teams. Consultations were audio-recorded, transcribed and thematically analysed. RESULTS: Seventy-six consultations were observed: 26 pre-dialysis consultations and two consultations each for 25 breast cancer patients. Key stages of the 'Three Talk Model' were observed. However, we also observed more elements and greater complexity: a distinct preparation phase; tailored and evolving integrative option conversation; patients and clinicians developing 'informed preferences'; distributed and multi-stage decisions; and a more open-ended planning discussion. Use of decision aids was limited. CONCLUSION: A more complex picture was observed compared with previous portrayals in current theoretical models. PRACTICE IIMPLICATIONS: The model can provide a basis for future training and initiatives to promote SDM, and tackle the gap between what is advocated in policy, but rarely achieved in practice.
OBJECTIVE: Research is needed to understand how Shared Decision-Making (SDM) is enacted in routine clinical settings. We aimed to 1) describe the process of SDM between clinicians and patients; 2) examine how well the SDM process compares to a prescriptive model of SDM, and 3) propose a descriptive model based on observed SDM in routine practice. METHODS:Patients with chronic kidney disease and early stage breast cancer were recruited consecutively via Cardiff and Vale University Health Board (UK) teams. Consultations were audio-recorded, transcribed and thematically analysed. RESULTS: Seventy-six consultations were observed: 26 pre-dialysis consultations and two consultations each for 25 breast cancerpatients. Key stages of the 'Three Talk Model' were observed. However, we also observed more elements and greater complexity: a distinct preparation phase; tailored and evolving integrative option conversation; patients and clinicians developing 'informed preferences'; distributed and multi-stage decisions; and a more open-ended planning discussion. Use of decision aids was limited. CONCLUSION: A more complex picture was observed compared with previous portrayals in current theoretical models. PRACTICE IIMPLICATIONS: The model can provide a basis for future training and initiatives to promote SDM, and tackle the gap between what is advocated in policy, but rarely achieved in practice.
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