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- W4323040897 abstract "In COVID vaccination stand-offs, what is “fact” for one is “fake” for another. Describing the effects of vaccines is counter-productive against positions or beliefs. Most patient-clinician interactions aren’t this extreme. Yet, the issue of what types of things can productively be discussed remains. Broadly, shared decision making (SDM) discusses problems, options, and preferences. Yet one person’s problem, “your blood sugar is too high” is not another’s “I can’t afford my insulin”. It’s not that they don’t share priorities, what type of problem diabetes is, is different. For the clinician diabetes is the effects of excessive blood glucose, for the patient, the day-to-day impediment to life. SDM is unlikely to be productive unless the clinician can switch from talking about effects to situations. Otherwise, they’re discussing fundamentally different things. Using a directed-content analysis based on Purposeful SDM and McKeon’s interpretive-orientations model we identified different types of things that are problems, options, and preferences in video-recorded encounters. Patients and clinicians are frequently talking about different types of things. E.g. The clinician describing a problem as the effects of osteoporosis, and the patient expressing the problem as a position “I won’t take medicines”. It is unproductive when this is unrecognized in conversation. Types of “things” that are problems, options, and preferences are: Effects, People’s positions, Situations, and Truths. For example, a problem may be located in competing positions, where options are alternative positions, and a preference is the acceptability of adopting another position. Alternatively, a problem may be the effects of illness, with options being counter effects with side effects, and preferences reactions to these effects. While discussing the same topic, patients and clinicians may be talking about different things. Evidence, decision aids, and medical science mostly discuss effects. Inclusiveness of other types of “things” is important in SDM." @default.
- W4323040897 created "2023-03-04" @default.
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- W4323040897 date "2023-04-01" @default.
- W4323040897 modified "2023-10-16" @default.
- W4323040897 title "Talking about completely different “things” in shared decision making" @default.
- W4323040897 doi "https://doi.org/10.1016/j.pec.2022.10.065" @default.
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