Search PubMed⌕ Search

Biomedical subjects

G Elwyn

Publications and source records attributed to G Elwyn.

43 records · Page 3Linked to original sources
PubMed1999

When is a shared decision not (quite) a shared decision? Negotiating preferences in a general practice encounter.

We consider whether there are situations in which 'shared decision making' in primary care is inherently problematic, such as in the demand for antibiotics to treat viral disorders. In such an instance there might be a lack of the equipoise necessary for a decision-making context in which apparent choices are genuine options. Using the techniques of discourse analysis on the transcript of a consultation with the parents of an infant with tonsillitis, we illustrate how a general practitioner's (GP's) efforts to reach a 'shared decision' come unstuck through a combination of the embedded power imbalance and the conflict between the GP's own prescription preferences and those of the parent.

Decision Making↗
PubMed1999

Shared decision-making in primary care: the neglected second half of the consultation.

The second half of the consultation is where decisions are made and future management agreed. We argue that this part of the clinical interaction has been 'neglected' during a time when communication skill development has been focused on uncovering and matching agendas. There are many factors, such as the increasing access to information and the emphasis on patient autonomy, which have led to the need to give more attention to both the skills and the information required to appropriately involve patients in the decision-making process. This analysis, based on a literature review, considers the concept of 'shared decision-making' and asks whether this approach is practical in the primary care setting. This study, and our ongoing research programme, indicates that future developments in this area depend on increasing the time available within consultations, require improved ways of communicating risk to patients, and an acquisition of new communication skills.

Ethics, Medical↗
PubMedDate not supplied

Presenting risk information--a review of the effects of "framing" and other manipulations on patient outcomes.

Discussing risks and benefits of treatments or care options is becoming an increasingly important part of modern health care. This paper reviews the literature about manipulations of risk and benefit information in the clinical setting. There is a paucity of evidence in this field, particularly when examining specific manipulations. Only three categories of manipulation had three or more studies. The available evidence shows that the way information is presented can have significant effects on decisions made. The largest effects are evident when relative risk information is presented, as compared with absolute risk data. In addition, "loss framing" is more effective in influencing screening uptake behaviors than "gain framing" (odds ratio 1.18 [95% confidence interval 1.01-1.38]). There is also a pattern of evidence from studies comparing simpler with more complex information, more data with less, and those comparing numerical with verbal descriptions of risks. These studies suggest that providing more information, and which is more understandable to the patient, is associated with improved patient knowledge and a greater wariness to take treatments or participate in trials. These findings can contribute to efforts to improve communication between professionals and patients.

Decision Making↗
PubMedDate not supplied

How should effectiveness of risk communication to aid patients' decisions be judged? A review of the literature.

Risk-communication interventions are associated with benefits at both the individual and the public health level. However, the types of outcomes used to assess the effectiveness of risk-communication interventions vary greatly. This makes synthesis of the research in systematic review difficult, and limits both the implementation of advances in clinical practice and further research. This article reviews the outcomes used in risk-communication publications, particularly those addressing individual decisions about treatment. From the traditional cognitive and behavioral research outcomes of patient knowledge, risk perception, and compliance, the emphasis has shifted towards more affective outcomes, including satisfaction, assessment of the information provided and the decision-making process, and certainty about whether the best option has been chosen. These affective outcomes may be more specific and sensitive measures for risk-communication research. Further development and validation of measurement scales to address these issues is needed.

Communication↗