Where is the problem to be solved? Problem defining and epistemic uncertainties in shared decision-making

Background

Physicians and patients apply different but overlapped knowledge in their contexts to define the divergent problems to solve during cancer treatment.

Objectives

This study aims to identify the knowledge sources of problem defining between physicians and patients in shared decision-making on cancer treatment.

Methods

This study adopted a divided narrative approach and interviewed 32 cancer patients and their paired 16 physicians from two top hospitals in northwestern China.

Results

Physicians defined problems by five types of knowledge sources structured in the social system and patients defined problems by five types of knowledge sources grounded in the individual system.

Discussion and Conclusions

Physicians and patients draw knowledge to define problems through asymmetric social mechanisms, which demonstrates the structural and cultural barriers to reaching mutual understanding and trust. However, a shared definition of the problem emerges from epistemic uncertainties in physician-patient interaction. Problem defining unfolds a chain of problems in shared decision-making, which can be potentially solved through narrative exchange at macro, meso, and micro levels.

Practice implications

This study suggests that, in shared decision-making, physicians can pay more attention to the cultural aspects of patients’ problem-defining narratives, while patients can be more aware of the social structural aspects of physicians’ problem-defining narratives.