Difference between revisions of "Chappell-etal2018"

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|Author(s)=Paul Chappell; Merran Toerien; Clare Jackson; Markus Reuber;
 
|Author(s)=Paul Chappell; Merran Toerien; Clare Jackson; Markus Reuber;
 
|Title=Following the patient's orders? Recommending vs. offering choice in neurology outpatient consultations
 
|Title=Following the patient's orders? Recommending vs. offering choice in neurology outpatient consultations
|Tag(s)=EMCA; In Press; Medical recommendations; Neurology; Patient choice; Doctor-patient interaction; Decision Making; Medical EMCA
+
|Tag(s)=EMCA; Medical recommendations; Neurology; Patient choice; Doctor-patient interaction; Decision Making; Medical EMCA
 
|Key=Chappell-etal2018
 
|Key=Chappell-etal2018
 
|Year=2018
 
|Year=2018
 
|Language=English
 
|Language=English
 
|Journal=Social Science & Medicine
 
|Journal=Social Science & Medicine
 +
|Volume=205
 +
|Pages=8–16
 
|URL=https://www.sciencedirect.com/science/article/pii/S0277953618301540
 
|URL=https://www.sciencedirect.com/science/article/pii/S0277953618301540
 
|DOI=https://doi.org/10.1016/j.socscimed.2018.03.036
 
|DOI=https://doi.org/10.1016/j.socscimed.2018.03.036
 
|Abstract=The UK's Royal College of Surgeons (2016) has argued that health professionals must replace a ‘paternalistic’ approach to consent with ‘informed choice’. We engage with these guidelines through analysis of neurology consultations in two UK-based neuroscience centres, where informed choice has been advocated for over a decade. Based on 223 recorded consultations and related questionnaire data (collected in 2012), we used conversation analysis (CA) to identify two practices for offering choice: patient view elicitors (PVEs) and option-lists. This paper reports further, mixed-methods analyses, combining CA with statistical techniques to compare the ‘choice’ practices with recommendations. Recommendations were overwhelmingly more common. There was little evidence that patient demographics determined whether choice was offered. Instead, decisional practices were associated with a range of clinical considerations. There was also evidence that individual neurologists tended to have a ‘style’, making it partly a matter of chance which decisional practice(s) patients encountered. This variability matters for the perception of choice: neurologists and patients were more likely to agree a choice had been offered if a PVE or option-list was used. It also matters for the outcome of the decision-making process: while recommendations nearly always ended in agreement to undertake the proffered course of action, option-lists and PVEs did so only about two-thirds of the time. While the direction of causality is unknown, this may indicate that patients are better enabled to refuse things they don't want when neurologists avoid recommending. We argue that our findings imply that neurologists tend to view choice as risky – in that the patient might make the ‘wrong’ choice – but that the inter-individual variation indicates that greater use of the more participatory practices is possible.
 
|Abstract=The UK's Royal College of Surgeons (2016) has argued that health professionals must replace a ‘paternalistic’ approach to consent with ‘informed choice’. We engage with these guidelines through analysis of neurology consultations in two UK-based neuroscience centres, where informed choice has been advocated for over a decade. Based on 223 recorded consultations and related questionnaire data (collected in 2012), we used conversation analysis (CA) to identify two practices for offering choice: patient view elicitors (PVEs) and option-lists. This paper reports further, mixed-methods analyses, combining CA with statistical techniques to compare the ‘choice’ practices with recommendations. Recommendations were overwhelmingly more common. There was little evidence that patient demographics determined whether choice was offered. Instead, decisional practices were associated with a range of clinical considerations. There was also evidence that individual neurologists tended to have a ‘style’, making it partly a matter of chance which decisional practice(s) patients encountered. This variability matters for the perception of choice: neurologists and patients were more likely to agree a choice had been offered if a PVE or option-list was used. It also matters for the outcome of the decision-making process: while recommendations nearly always ended in agreement to undertake the proffered course of action, option-lists and PVEs did so only about two-thirds of the time. While the direction of causality is unknown, this may indicate that patients are better enabled to refuse things they don't want when neurologists avoid recommending. We argue that our findings imply that neurologists tend to view choice as risky – in that the patient might make the ‘wrong’ choice – but that the inter-individual variation indicates that greater use of the more participatory practices is possible.
 
}}
 
}}

Latest revision as of 14:53, 11 October 2019

Chappell-etal2018
BibType ARTICLE
Key Chappell-etal2018
Author(s) Paul Chappell, Merran Toerien, Clare Jackson, Markus Reuber
Title Following the patient's orders? Recommending vs. offering choice in neurology outpatient consultations
Editor(s)
Tag(s) EMCA, Medical recommendations, Neurology, Patient choice, Doctor-patient interaction, Decision Making, Medical EMCA
Publisher
Year 2018
Language English
City
Month
Journal Social Science & Medicine
Volume 205
Number
Pages 8–16
URL Link
DOI https://doi.org/10.1016/j.socscimed.2018.03.036
ISBN
Organization
Institution
School
Type
Edition
Series
Howpublished
Book title
Chapter

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Abstract

The UK's Royal College of Surgeons (2016) has argued that health professionals must replace a ‘paternalistic’ approach to consent with ‘informed choice’. We engage with these guidelines through analysis of neurology consultations in two UK-based neuroscience centres, where informed choice has been advocated for over a decade. Based on 223 recorded consultations and related questionnaire data (collected in 2012), we used conversation analysis (CA) to identify two practices for offering choice: patient view elicitors (PVEs) and option-lists. This paper reports further, mixed-methods analyses, combining CA with statistical techniques to compare the ‘choice’ practices with recommendations. Recommendations were overwhelmingly more common. There was little evidence that patient demographics determined whether choice was offered. Instead, decisional practices were associated with a range of clinical considerations. There was also evidence that individual neurologists tended to have a ‘style’, making it partly a matter of chance which decisional practice(s) patients encountered. This variability matters for the perception of choice: neurologists and patients were more likely to agree a choice had been offered if a PVE or option-list was used. It also matters for the outcome of the decision-making process: while recommendations nearly always ended in agreement to undertake the proffered course of action, option-lists and PVEs did so only about two-thirds of the time. While the direction of causality is unknown, this may indicate that patients are better enabled to refuse things they don't want when neurologists avoid recommending. We argue that our findings imply that neurologists tend to view choice as risky – in that the patient might make the ‘wrong’ choice – but that the inter-individual variation indicates that greater use of the more participatory practices is possible.

Notes