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Communication practices that encourage and constrain shared decision making in health-care encounters: Systematic review of conversation analytic research

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journal contribution
posted on 06.04.2018 by Victoria Land, Ruth Parry, Jane Seymour
© 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd Background: Shared decision making (SDM) is generally treated as good practice in health-care interactions. Conversation analytic research has yielded detailed findings about decision making in health-care encounters. Objective: To map decision making communication practices relevant to health-care outcomes in face-to-face interactions yielded by prior conversation analyses, and to examine their function in relation to SDM. Search strategy: We searched nine electronic databases (last search November 2016) and our own and other academics' collections. Inclusion criteria: Published conversation analyses (no restriction on publication dates) using recordings of health-care encounters in English where the patient (and/or companion) was present and where the data and analysis focused on health/illness-related decision making. Data extraction and synthesis: We extracted study characteristics, aims, findings relating to communication practices, how these functioned in relation to SDM, and internal/external validity issues. We synthesised findings aggregatively. Results: Twenty-eight publications met the inclusion criteria. We sorted findings into 13 types of communication practices and organized these in relation to four elements of decision-making sequences: (i) broaching decision making; (ii) putting forward a course of action; (iii) committing or not (to the action put forward); and (iv) HCPs' responses to patients' resistance or withholding of commitment. Patients have limited opportunities to influence decision making. HCPs' practices may constrain or encourage this participation. Conclusions: Patients, companions and HCPs together treat and undertake decision making as shared, though to varying degrees. Even for non-negotiable treatment trajectories, the spirit of SDM can be invoked through practices that encourage participation (eg by bringing the patient towards shared understanding of the decision's rationale).

Funding

Dr Land’s work was supported by a Small Grants Scheme award from the School of Health Sciences, University of Nottingham. Dr Parry is funded by a National Institute for Health Research Career Development Fellowship award CDF-2014-07-046. This review presents independent research in part funded by the National Institute for Health Research (NIHR).

History

School

  • Social Sciences

Department

  • Communication, Media, Social and Policy Studies

Published in

Health Expectations

Volume

20

Issue

6

Pages

1228 - 1247

Citation

LAND, V., PARRY, R. and SEYMOUR, J., 2017. Communication practices that encourage and constrain shared decision making in health-care encounters: Systematic review of conversation analytic research. Health Expectations, 20(6), pp. 1228-1247.

Publisher

© The Authors. Published by Wiley

Version

VoR (Version of Record)

Publisher statement

This work is made available according to the conditions of the Creative Commons Attribution 4.0 International (CC BY 4.0) licence. Full details of this licence are available at: http://creativecommons.org/licenses/ by/4.0/

Publication date

2017-05-18

Notes

This is an Open Access Article. It is published by Wiley under the Creative Commons Attribution 4.0 Unported Licence (CC BY). Full details of this licence are available at: http://creativecommons.org/licenses/by/4.0/

ISSN

1369-6513

eISSN

1369-7625

Language

en

Licence

Exports