'My cousin said to me . . .' Patients' use of third-party references to facilitate shared decision-making during naturally occurring primary care consultations.

IF 1.9 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Health Pub Date : 2024-09-01 Epub Date: 2023-07-30 DOI:10.1177/13634593231188489
Olaug S Lian, Sarah Nettleton, Huw Grange, Christopher Dowrick
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引用次数: 0

Abstract

In this paper, we explore the ways in which patients invoke third parties to gain decision-making influence in clinical consultations. The patients' role in decision-making processes is often overlooked, and this interactional practice has rarely been systematically studied. Through a contextual narrative exploration of 42 naturally occurring consultations between patients (aged 22-84) and general practitioners (GPs) in England, we seek to fill this gap. By exploring how and why patients invoke third parties during discussions about medical treatments, who they refer to, what kind of knowledge their referents possess, and how GPs respond, our main aim is to capture the functions and implications of this interactional practice in relation to decision-making processes. Patients refer to third parties during decision-making processes in most of the consultations, usually to argue for and against certain treatment options, and the GPs recognise these utterances as pro-and-contra arguments. This enables patients to counter the GPs' professional knowledge through various knowledge-sources and encourage the GPs to target their specific concerns. By attributing arguments to third parties, patients claim decision-making influence without threatening the GPs' authority and expertise, which their disadvantaged epistemic position demands. Thereby, patients become able to negotiate their role and their epistemic position, to influence the agenda-setting, and to take part in the decision-making process, without being directly confrontational. Invoking third parties is a non-confrontational way of proposing and opposing treatment options that might facilitate successful patient participation in decision-making processes, and so limit the risk of patients being wronged in their capacity as knowers.

我表弟对我说......'在自然发生的初级医疗咨询中,患者利用第三方参考资料促进共同决策。
在本文中,我们将探讨在临床咨询中,患者如何借助第三方来影响决策。患者在决策过程中的作用常常被忽视,这种互动实践也很少被系统研究。通过对英格兰 42 个自然发生的患者(22-84 岁)与全科医生(GPs)之间的咨询进行情境叙事探索,我们试图填补这一空白。我们的主要目的是通过探究患者在讨论医疗过程中如何以及为何援引第三方、他们援引了谁、他们的参照物拥有何种知识以及全科医生如何回应,来捕捉这种与决策过程相关的互动实践的功能和意义。在大多数咨询中,患者在决策过程中都会提及第三方,通常是为了支持或反对某些治疗方案,而全科医生会将这些话语视为支持和反对的论点。这使患者能够通过各种知识来源反驳全科医生的专业知识,并鼓励全科医生针对他们的具体问题进行治疗。通过将论点归因于第三方,患者可以在不威胁全科医生权威和专业知识的情况下对决策施加影响,而这正是他们处于弱势的认识论地位所要求的。因此,患者能够在不直接对抗的情况下,协商自己的角色和认识论立场,影响议程设置,并参与决策过程。邀请第三方是提出和反对治疗方案的一种非对抗性方式,可以促进患者成功参与决策过程,从而限制患者作为知情者受到伤害的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Health
Health Multiple-
CiteScore
4.90
自引率
0.00%
发文量
0
期刊介绍: Health: is published four times per year and attempts in each number to offer a mix of articles that inform or that provoke debate. The readership of the journal is wide and drawn from different disciplines and from workers both inside and outside the health care professions. Widely abstracted, Health: ensures authors an extensive and informed readership for their work. It also seeks to offer authors as short a delay as possible between submission and publication. Most articles are reviewed within 4-6 weeks of submission and those accepted are published within a year of that decision.
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