Communication practices that encourage and constrain shared decision making in health-care encounters: Systematic review of conversation analytic research

Background: Shared decision making (SDM) is generally treated as good practice in healthcare interactions. Conversation analytic research has yielded detailed findings about decision making in healthcare encounters.

Objective: To map decision making communication practices relevant to healthcare outcomes in face-to-face interactions yielded by prior conversation analyses, and to examine their function in relation to SDM.

Search strategy: We searched nine electronic databases (last search November 2016) and our own and other academics’ collections.

Inclusion criteria: Published conversation analyses (no restriction on publication dates) using recordings of healthcare encounters in English where the patient (and/or companion) was present and where the data and analysis focused on health/illness-related decision making.

Data extraction and synthesis: We extracted study characteristics, aims, findings relating to communication practices, how these functioned in relation to SDM, and internal/external validity issues. We synthesised findings aggregatively.

Results: Twenty-eight publications met the inclusion criteria. We sorted findings into 13 types of communication practices and organised these in relation to four elements of decision making sequences: (1) broaching decision making; (2) putting forward a course of action; (3) committing or not (to the action put forward); and (4) HCPs’ responses to patients’ resistance or withholding of commitment. Patients have limited opportunities to influence decision making. HCPs’ practices may constrain or encourage this participation.

Conclusions: Patients, companions and HCPs together treat and undertake decision making as shared, though to varying degrees. Even for non-negotiable treatment trajectories, the spirit of SDM can be invoked through practices that encourage participation (e.g. by bringing the patient towards shared understanding of the decision’s rationale).