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Patient-doctor decision-making about treatment within the consultation--A critical analysis of models

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  • Wirtz, Veronika
  • Cribb, Alan
  • Barber, Nick

Abstract

This paper highlights some of the limitations of models of patient involvement in decision-making and explores the reasons for, and implications of, these limitations. Taking the three models of interpretative, shared and informed decision-making as examples, we focus on two limitations of the models: (1) neglect of which decisions the patient should be involved in (the framing problem) and (2) how the patient should be involved in decision-making (the nature of reasoning problem). Although there will inevitably be a gap between models and practice--this much is in the nature of the models--we suggest that these two issues are substantially neglected by the models and yet are fundamental to understanding patient-doctor decision-making. We also suggest that the fundamental problem that lies behind these limitations is insufficient attention to, and explicitness about, the dilemmas of professional ethics, which are played out in the professional-patient relationships that the models are supposed to represent, particularly with respect to the issue of expert and lay accountability.

Suggested Citation

  • Wirtz, Veronika & Cribb, Alan & Barber, Nick, 2006. "Patient-doctor decision-making about treatment within the consultation--A critical analysis of models," Social Science & Medicine, Elsevier, vol. 62(1), pages 116-124, January.
  • Handle: RePEc:eee:socmed:v:62:y:2006:i:1:p:116-124
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    References listed on IDEAS

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    1. Sculpher, Mark & Gafni, Amiram & Watt, Ian, 2002. "Shared treatment decision making in a collectively funded health care system: possible conflicts and some potential solutions," Social Science & Medicine, Elsevier, vol. 54(9), pages 1369-1377, May.
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    5. Charles, Cathy & Gafni, Amiram & Whelan, Tim, 1999. "Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model," Social Science & Medicine, Elsevier, vol. 49(5), pages 651-661, September.
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    Cited by:

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    2. Ishikawa, Hirono & Hashimoto, Hideki & Kiuchi, Takahiro, 2013. "The evolving concept of “patient-centeredness” in patient–physician communication research," Social Science & Medicine, Elsevier, vol. 96(C), pages 147-153.
    3. Clinch, Megan & Benson, John, 2013. "Making information ‘relevant’: General Practitioner judgments and the production of patient involvement," Social Science & Medicine, Elsevier, vol. 96(C), pages 104-111.
    4. Duberstein, Paul R. & Hoerger, Michael & Norton, Sally A. & Mohile, Supriya & Dahlberg, Britt & Hyatt, Erica Goldblatt & Epstein, Ronald M. & Wittink, Marsha N., 2023. "The TRIBE model: How socioemotional processes fuel end-of-life treatment in the United States," Social Science & Medicine, Elsevier, vol. 317(C).
    5. Marion Haas & Siggi Zapart & Rosalie Viney, 2007. "Patients? perceptions of the value of PET in diagnosis and management of non-small call lung cancer, CHERE Working Paper 2007/5," Working Papers 2007/5, CHERE, University of Technology, Sydney.
    6. Mendick, Nicola & Young, Bridget & Holcombe, Christopher & Salmon, Peter, 2010. "The ethics of responsibility and ownership in decision-making about treatment for breast cancer: Triangulation of consultation with patient and surgeon perspectives," Social Science & Medicine, Elsevier, vol. 70(12), pages 1904-1911, June.

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