Shared decision making: trade-offs between narrower and broader conceptions

Cribb, Alan; Entwistle, Vikki

doi:10.1111/j.1369-7625.2011.00694.x

Cited by 108 publications

(151 citation statements)

References 22 publications

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“…However, a focus on increasing AR assessment overall may not reflect the complexities of primary care -GPs may have good reasons for not following guidelines, including patient preferences. 27,28 GPs' concerns about competing priorities warrant further investigation into how guidelines can reconcile a patient-centred approach with prevention targets.…”

Section: Discussionmentioning

confidence: 99%

General practitioners’ use of different cardiovascular risk assessment strategies: a qualitative study

Bonner

Jansen

McKinn

et al. 2013

Medical Journal of Australia

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Research urrent guidelines for cardiovascular disease (CVD) prevention advocate the use of absolute risk (AR) assessment to guide the use of preventive medication, rather than treating blood pressure and cholesterol separately. 2-5 Age, sex, smoking, diabetes, systolic blood pressure and cholesterol ratio are used to estimate the risk of a cardiovascular event in the next 5 years. Preventive medication is recommended if AR is higher than 15%, or 10%-15% with other risk factors. 2,3 Reviews suggest that the AR approach may improve the clinical management of CVD without harm to patients. 6,7 Basing treatment decisions on high AR rather than high individual risk factors may prevent overtreatment of patients with isolated risk factors but low to moderate overall risk, and undertreatment of patients with high overall risk. 8,9 However, international 10-13 and Australian 14-18 research suggests that CVD risk management is not consistently based on AR. Possible barriers to general practitioners using AR assessment include lack of time, accessibility, knowledge and trust; conflicting guidelines; difficulty understanding and explaining AR; and focusing on individual risk factors that may not be included in AR models.10-18 According to the "behaviour change wheel" framework, these factors may act as barriers to the use of AR assessment through three determinants of behaviour: opportunity (eg, access), capability (eg, knowledge) and motivation (eg, trust). 19Little is known about how and why GPs do use AR in CVD risk assessment, and the alternative strategies employed when AR is not the focus of assessment. We aimed to investigate GPs' views and experiences of CVD risk assessment to identify factors that influence the extent to which Australian AR assessment guidelines are used. MethodsWe used purposive sampling to recruit participants, aiming for maximum variation among a set of characteristics known to influence CVD risk management (Box 1). [20][21][22] Invitation letters were posted to all 3743 members of eight Divisions of General Practice in metropolitan New South Wales. Of 55 GPs who returned expression of interest forms, we allocated 25 to this study. GPs signed a consent form before participating in person (two participants) or via telephone (23 participants). They received $100 for their time. Preliminary analysis suggested saturation of key themes related to the range of CVD risk assessment strategies described by GPs, so no further recruitment was conducted.23 Ethics approval was obtained through the Sydney Local Health District Human Research Ethics Committee.A semi-structured interview schedule covering CVD risk assessment and management was developed (Appendix 1; online at mja.com.au), piloted with two GPs, and clarified. Interviews lasted between 22 and 55 minutes, and de-identified audiorecordings were transcribed verbatim. Between October 2011 and May 2012, interviews were conducted by two of us (C B, S M) who have qualifications in public health.We used a framework analysis method 24 and summarised data w...

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Section: Discussionmentioning

confidence: 99%

General practitioners’ use of different cardiovascular risk assessment strategies: a qualitative study

Bonner

Jansen

McKinn

et al. 2013

Medical Journal of Australia

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“…Discussion continues about whether broader or narrower definitions should prevail and what precise skills SDM requires of physicians [21,22]. Some argue that patients do not necessarily want to share decisions-they want the doctor to make the decision for them [23].…”

Section: Determine the Decision To Be Madementioning

confidence: 99%

Is Shared Decision Making a Utopian Dream or an Achievable Goal?

Blair

2015

Patient

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The idea of shared decision making (SDM) between patient and physician grew out of a generalized challenge to traditional social hierarchies that occurred in the middle of the last century. Governments have espoused SDM, thousands of articles about it have been published, and evidence has shown that it improves some of the healthcare processes as well as patient outcomes. Yet it has not been widely adopted. From their cross-disciplinary perspective (practical theology and clinical medicine), the authors locate this reluctance in the unfolding of scientific paradigm shifts, summarize the perceived risks and benefits of SDM and the evidence for each, and suggest practical, achievable approaches for clinicians. Finally, they explore some important emerging territories for SDM. Key Points for Decision MakersShared decision making (SDM) has proved its worth and is achievable … but debates continue.Several validated models are available right now for use in clinical practice.People can and are being successfully trained in SDM.SDM is needed to address emerging value-laden clinical decisions such as those about caring for the elderly and about genetic testing.

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“…However, for a human actor (e.g. a health professional or personal trainer) to support another actor's procedural autonomy is a highly skilled and dilemma-laden practice (Cribb and Entwistle 2011), and this suggests that there are grounds to be sceptical about the capacity of a 'non-human actor' to achieve this same feat and to negotiate the same balancing acts. In what remains of the article, we raise concerns that these technologies may not necessarily align with, or be responsive to, users' genuine volitions in a straightforward or consistent way.…”

Section: Reconsidering Wearable Technologies and Procedural Autonomymentioning

confidence: 99%

‘My Fitbit Thinks I Can Do Better!’ Do Health Promoting Wearable Technologies Support Personal Autonomy?

Owens

Cribb

2017

Philos. Technol.

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This paper critically examines the extent to which health promoting wearable technologies can provide people with greater autonomy over their health. These devices are frequently presented as a means of expanding the possibilities people have for making healthier decisions and living healthier lives. We accept that by collecting, monitoring, analysing and displaying biomedical data, and by helping to underpin motivation, wearable technologies can support autonomy over health. However, we argue that their contribution in this regard is limited and that-even with respect to their 'autonomy enhancing' potential-these devices may deliver costs as well as benefits. We proceed by rehearsing the distinction that can be drawn between procedural autonomy (which refers to processes of psychological deliberation) and substantiverelational autonomy (which refers to the opportunities people have for exercising potential actions). While the information provided by wearable technologies may support deliberation and decision-making, in isolation these technologies do little to provide substantive opportunities to act and achieve better health. As a consequence, wearable technologies risk generating burdens of anxiety and stigma for their users and reproducing existing health inequalities. We then reexamine the extent to which wearable technologies actually support autonomous deliberation. We argue that wearable technologies that subject their users to biomedical and consumerist epistemologies, norms and values also risk undermining processes of genuinely autonomous deliberation.

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Shared decision making: trade-offs between narrower and broader conceptions

Cited by 108 publications

References 22 publications

General practitioners’ use of different cardiovascular risk assessment strategies: a qualitative study

General practitioners’ use of different cardiovascular risk assessment strategies: a qualitative study

Is Shared Decision Making a Utopian Dream or an Achievable Goal?

‘My Fitbit Thinks I Can Do Better!’ Do Health Promoting Wearable Technologies Support Personal Autonomy?

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