Shared decision-making during prostate cancer consultations: implications of clinician misalignment with patient and partner preferences
Shared decision-making during prostate cancer consultations: implications of clinician misalignment with patient and partner preferences
Concepts of patient-centredness and shared decision-making inform expectations that clinicians should display sensitivity to patients' expressed preferences. This study examines the organisation of treatment-related preferences expressed by patients and their partners during clinical consultations for people with localised prostate cancer. A conversation analysis of twenty-eight diagnosis and treatment consultations was conducted with data recorded from four clinical sites across England. When clinicians disaligned from expressions of preference such as directing talk away from expressions, or moving to redress perceived misunderstandings, it caused discordance in the unfolding interaction. This led to couples silencing themselves. Two deviant cases were identified that did not feature the misalignment found in all other collected cases. In these two cases, the interaction remained collaborative. These findings highlight the immediate consequences of expressions of preference being resisted, rejected, and dismissed in a context where clinicians are expected to explore expressed preferences in service of SDM. The deviant case analysis offers an alternative practice to the pattern observed across the collection, offering a comparison between misaligned sequences, and cases where social solidarity was maintained. By acknowledging couple's expressions as valid contributions, rather than acting to inform or correct them, clinicians can create opportunity spaces for discussion around treatment preferences.
Conflict, Conversation analysis, Partners, Prostate cancer, Shared decision making, Treatment decision making
Stewart, Simon John
848b5f2b-dafa-4bf0-bcd4-35bb9e835466
Roberts, Lisa
d87fdb50-6185-498a-a60c-466eace1c4ca
Brindle, Lucy
17158264-2a99-4786-afc0-30990240436c
July 2023
Stewart, Simon John
848b5f2b-dafa-4bf0-bcd4-35bb9e835466
Roberts, Lisa
d87fdb50-6185-498a-a60c-466eace1c4ca
Brindle, Lucy
17158264-2a99-4786-afc0-30990240436c
Stewart, Simon John, Roberts, Lisa and Brindle, Lucy
(2023)
Shared decision-making during prostate cancer consultations: implications of clinician misalignment with patient and partner preferences.
Social Science and Medicine, 329, [115969].
(doi:10.1016/j.socscimed.2023.115969).
Abstract
Concepts of patient-centredness and shared decision-making inform expectations that clinicians should display sensitivity to patients' expressed preferences. This study examines the organisation of treatment-related preferences expressed by patients and their partners during clinical consultations for people with localised prostate cancer. A conversation analysis of twenty-eight diagnosis and treatment consultations was conducted with data recorded from four clinical sites across England. When clinicians disaligned from expressions of preference such as directing talk away from expressions, or moving to redress perceived misunderstandings, it caused discordance in the unfolding interaction. This led to couples silencing themselves. Two deviant cases were identified that did not feature the misalignment found in all other collected cases. In these two cases, the interaction remained collaborative. These findings highlight the immediate consequences of expressions of preference being resisted, rejected, and dismissed in a context where clinicians are expected to explore expressed preferences in service of SDM. The deviant case analysis offers an alternative practice to the pattern observed across the collection, offering a comparison between misaligned sequences, and cases where social solidarity was maintained. By acknowledging couple's expressions as valid contributions, rather than acting to inform or correct them, clinicians can create opportunity spaces for discussion around treatment preferences.
Text
347 Shared decision-making during prostate cancer consultations Implications of clinician misalignment with patient and partner preferences
- Accepted Manuscript
More information
Accepted/In Press date: 13 May 2023
e-pub ahead of print date: 23 May 2023
Published date: July 2023
Additional Information:
Funding Information:
The lead author was funded and supported by the ESRC South Coast Doctoral Training Partnership , Ref: ES/J500161/1 .
Funding Information:
The Understanding Consequences Study (Chief Investigator: Brindle) was funded by TrueNTH: A collaboration between Prostate Cancer UK and Movember.
Publisher Copyright:
© 2023 Elsevier Ltd
Keywords:
Conflict, Conversation analysis, Partners, Prostate cancer, Shared decision making, Treatment decision making
Identifiers
Local EPrints ID: 477434
URI: http://eprints.soton.ac.uk/id/eprint/477434
ISSN: 0277-9536
PURE UUID: 3b77e021-df0c-4d22-af04-d44ab628639c
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Date deposited: 06 Jun 2023 16:56
Last modified: 17 Mar 2024 03:05
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Contributors
Author:
Simon John Stewart
Author:
Lisa Roberts
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