Shared decision-making during prostate cancer consultations: Implications of clinician misalignment with patient and partner preferences

Stewart, Simon J, Roberts, Lisa and Brindle, Lucy (2023) Shared decision-making during prostate cancer consultations: Implications of clinician misalignment with patient and partner preferences. Social Science & Medicine, 329. ISSN 0277-9536

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Abstract or description

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.

Item Type:	Article
Faculty:	School of Life Sciences and Education > Psychology and Counselling
Depositing User:	Simon STEWART
Date Deposited:	07 Jun 2023 11:07
Last Modified:	23 Oct 2023 14:45
URI:	https://eprints.staffs.ac.uk/id/eprint/7788

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