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

Author:

Rake Ester AORCID,Meinders Marjan J,Brand Guus,Dreesens DunjaORCID,Kremer Jan A M,Elwyn GlynORCID,Aarts Johanna W M

Abstract

ObjectivesPatients’ 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.DesignCross-sectional study: observational coding based on a novel coding scheme of audio-recorded outpatient clinical encounters where encounter patient decision aids were applied.SettingWe 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.ParticipantsTwenty patients who suffered from psoriasis or ovarian cysts; four clinicians.ResultsWe included 20 audio-recordings. The mean Observer OPTION5score 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.ConclusionsThe 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.

Funder

The Knowledge Institute of the Dutch Association of Medical Specialists

Publisher

BMJ

Reference49 articles.

1. Institute of Medicine (US) Committee on Quality of Health Care in America . Crossing the quality chasm: a new health system for the 21st century. Washington (DC) National Academies Press (US); 2001.

2. Gerteis M , Edgman-Levitan S , Daley J , et al . Through the Patient’s Eyes: Understanding and Promoting Patient-Centered Care. 1st edn. San Francisco: Jossey-Bass Publishers, 1993.

3. A three-talk model for shared decision making: multistage consultation process;Elwyn;BMJ,2017

4. Contextual Errors and Failures in Individualizing Patient Care

5. Shared Decision Making

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3