1. A descriptive model of shared decision making derived from routine implementation in clinical practice ('Implement-SDM'): Qualitative study.
- Author
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Joseph-Williams N, Williams D, Wood F, Lloyd A, Brain K, Thomas N, Prichard A, Goodland A, McGarrigle H, Sweetland H, and Edwards A
- Subjects
- Adult, Communication, Female, Humans, Male, Models, Theoretical, Qualitative Research, Wales, Breast Neoplasms therapy, Decision Making, Shared, Kidney Failure, Chronic therapy, Physician-Patient Relations
- Abstract
Objective: Research is needed to understand how Shared Decision-Making (SDM) is enacted in routine clinical settings. We aimed to 1) describe the process of SDM between clinicians and patients; 2) examine how well the SDM process compares to a prescriptive model of SDM, and 3) propose a descriptive model based on observed SDM in routine practice., Methods: Patients with chronic kidney disease and early stage breast cancer were recruited consecutively via Cardiff and Vale University Health Board (UK) teams. Consultations were audio-recorded, transcribed and thematically analysed., Results: Seventy-six consultations were observed: 26 pre-dialysis consultations and two consultations each for 25 breast cancer patients. Key stages of the 'Three Talk Model' were observed. However, we also observed more elements and greater complexity: a distinct preparation phase; tailored and evolving integrative option conversation; patients and clinicians developing 'informed preferences'; distributed and multi-stage decisions; and a more open-ended planning discussion. Use of decision aids was limited., Conclusion: A more complex picture was observed compared with previous portrayals in current theoretical models., Practice Iimplications: The model can provide a basis for future training and initiatives to promote SDM, and tackle the gap between what is advocated in policy, but rarely achieved in practice., (Copyright © 2019 Elsevier B.V. All rights reserved.)
- Published
- 2019
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