Background
Shared decision making (SDM) is a widely acknowledged gold standard of communicative practice in healthcare. SDM occurs in many contexts but is especially relevant in preference sensitive care associated breast cancer treatment. Previous research evaluates clinicians’ awareness of SDM and – to a lesser extent – patients’ understanding of it. However detailed examinations of how it discursively transpires in consultations are scarce.
Method
Ten audio recordings of adjuvant treatment consultations were transcribed using Jefferson conventions and subjected to conversation analysis (CA). CA focused on basic content, turn-taking, speech repairs, expansions and sequencing. The study was approved by University and associated health service Research Ethics Committees
Results
Three recurrent discursive practices took place during doctor-patient interaction.
1) Fragmented conversations included use of boundary markers at transitional points during the consultation. E.g., clinicians made regular use of the word ‘so’, to signify a new section of talk and instructing the patient to listen.
2) Territories of knowledge and epistemic markers: words such as, ‘we see’, and ‘we are’, created an implied understanding of a majority group that excluded the patient.
3) Extending multi-turn utterances: several transition relevance places (TRPs) appeared in the data, indicating that patients were implicitly invited to speak, but usually did not.
Conclusion
Patients did not appear to discern cues inviting their decisions which subsequently inhibited SDM. This suggests that the presence of SDM in consultations is controlled by patients’ participatory roles and that attention needs to focus on more CA to determine patient-led recommendations for how SDM should occur.