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Title: Communication practices that encourage and constrain shared decision making in health-care encounters: Systematic review of conversation analytic research
Authors: Land, Victoria
Parry, Ruth
Seymour, Jane
Keywords: Conversation analysis
Medical interaction
Patient choice
Patient participation
Shared decision making
Systematic review
Issue Date: 2017
Publisher: © The Authors. Published by Wiley
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.
Abstract: © 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).
Description: 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/
Sponsor: 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).
Version: Published
DOI: 10.1111/hex.12557
URI: https://dspace.lboro.ac.uk/2134/32458
Publisher Link: https://doi.org/10.1111/hex.12557
ISSN: 1369-6513
Appears in Collections:Published Articles (Social Sciences)

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