Eliciting patient preferences in shared decision-making (SDM): Comparing conversation analysis and SDM measurements

Abstract

Objective: To explore how physicians bring up patient preferences, and how it aligns with assessments of shared decision-making. Methods: Qualitative conversation analysis of physicians formulating hypotheses about the patient’s treatment preference was compared with quantitative scores on SDM and ‘patient preferences’ using OPTION(5) and MAPPIN’SDM. Results: Physicians occasionally formulate hypotheses about patients’ preferences and then present a treatment option on the basis of that (“if you think X + we can do Y”). This practice may promote SDM in that the decisions are treated as contingent on patient preferences. However, the way these hypotheses are formulated, simultaneously constrains the patient’s freedom of choice and exerts a pressure to accept the physician’s recommendation. These opposing effects may in part explain cases where different assessment instruments yield large variations in SDM measures. Conclusion: Eliciting patient preferences is a complex phenomenon that can be difficult to reduce into an accurate number. Detailed analysis can shed light on how patient preferences are elicited, and its consequences for patient involvement. Comparing CA and SDM measurements can contribute to specifying communicative actions that SDM scores are based on. Practice implications: Our findings have implications for SDM communication skills training and further development of SDM measurements.