Communication practices that encourage participation in healthcare decision-making by patients: a systematic review of conversation analytic studies

Project Duration

June 2012 – December 2014

Funder

School of Health Sciences, University of Nottingham (Small Grants Scheme)

Aims

• Identify and describe interactional practices employed in the course of decision-making in naturalistic medical/healthcare interactions  
• Summarise evidence on the functioning of the practices identified, focusing in particular on their role in constraining, allowing, or encouraging participation in decision-making
• Use findings to inform policy, training and practice on providing opportunities for participation by patients, carers and proxies in healthcare decision-making

Methods

Systematic review and synthesis of conversation analytic research on English Language data published in English.

Stage of Development

A draft paper reporting the findings is in preparation, with submission to a journal planned for early Autumn 2015. One key focus of the paper is on how the empirical research suggests we can think of communication about decisions within healthcare interactions as involving two kinds of activities – (1) enabling/allowing patients to influence the actual decision/choice made, and (2) efforts to bring the parties involved towards parity of knowledge, stance, reasoning, and motivations underpinning the decision. The latter are particularly relevant in circumstances where there is little leeway for doctors or patients to influence the decision itself, for example when a patient does not fulfil the providing organisation’s criteria for a particular intervention, neither doctor nor patient has much influence over the actual decision.