ABSTRACT
In COVID vaccination stand-offs, what is "fact" for one is "fake" for another. Describing the effects of vaccines is counter-productive against positions or beliefs. Most patient-clinician interactions aren't this extreme. Yet, the issue of what types of things can productively be discussed remains. Broadly, shared decision making (SDM) discusses problems, options, and preferences. Yet one person's problem, "your blood sugar is too high" is not another's "I can't afford my insulin". It's not that they don't share priorities, what type of problem diabetes is, is different. For the clinician diabetes is the effects of excessive blood glucose, for the patient, the day-to-day impediment to life. SDM is unlikely to be productive unless the clinician can switch from talking about effects to situations. Otherwise, they're discussing fundamentally different things. Using a directed-content analysis based on Purposeful SDM and McKeon's interpretive-orientations model we identified different types of things that are problems, options, and preferences in video-recorded encounters. Patients and clinicians are frequently talking about different types of things. E.g. The clinician describing a problem as the effects of osteoporosis, and the patient expressing the problem as a position "I won't take medicines". It is unproductive when this is unrecognized in conversation. Types of "things" that are problems, options, and preferences are: Effects, People's positions, Situations, and Truths. For example, a problem may be located in competing positions, where options are alternative positions, and a preference is the acceptability of adopting another position. Alternatively, a problem may be the effects of illness, with options being counter effects with side effects, and preferences reactions to these effects. While discussing the same topic, patients and clinicians may be talking about different things. Evidence, decision aids, and medical science mostly discuss effects. Inclusiveness of other types of "things" is important in SDM. [ABSTRACT FROM AUTHOR] Copyright of Patient Education & Counseling is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
ABSTRACT
OBJECTIVES: To assess the extent to which shared decision making (SDM) can take place in telemedicine (remote SDM). METHODS: We searched Medline, Cochrane, and Scopus from 2010 until August 7th, 2020 for articles on remote SDM in the care of any patient using any technology. We also conducted a search for telemedicine articles citing key reports on SDM outcome measures. Two reviewers independently screened titles and abstracts, reviewed full text eligible studies, and synthesized their content using thematic analysis. RESULTS: Of the 12 eligible articles, most were European with patients with chronic disease or mental and behavioral health. 8 articles used synchronous remote SDM and 1 used asynchronous remote SDM. Themes related to interactional workability of both telemedicine technologies and SDM emerged, namely access to broadband, digital literacy, and satisfaction with the convenience of remote visits. CONCLUSIONS: Telemedicine technologies may foster virtual interactions that support remote SDM, which, in turn, may promote productive patient-clinician interactions and patient-centered care. PRACTICE IMPLICATIONS: Digitally-mediated consultations surged amidst the COVID-19 pandemic. The extent to which SDM frameworks developed for in-person use need any adaptation for remote SDM remains unclear. Investment in innovation, design, implementation, and effectiveness research to advance remote SDM are needed.