Call For Abstracts: Continuity and Change in the Study of Medical Decision-Making
SfAA Annual Meeting 2015
Over the last three decades, research in anthropology and related fields of social and behavioral science have been instrumental in furthering our understanding of medical decision-making. Moreover, they have proposed changes in the processes of medical decision-making in order to directly engage the patient in making decisions about their care. The proposition to engage patients in decision-making signaled a departure from the paternalistic physician-centered clinical decision-making that had historically dominated clinical practice (Brody 1980; Stiggelbout et al. 2012). In so doing, researchers have approached patient engagement in medical decision-making from numerous angles: identifying and developing models (Brody 1980; Garro 1998a and b; Charles, Gafni, and Whelan 1997; Charles, Gafni, and Whelan 1999; Elwyn et al. 2014; Makoul and Clayman 2006; Towle and Godolphin 1999; Young 1980); gauging patient interest and role preference in decision-making (Degner, Sloan, and Venkatesh 1997; Deber, Kraetschmer, and Irvine 1996); understanding decision conflict (O’Connor 1995); evaluating decision satisfaction and/or decision regret (Brehaut et al. 2003; Holmes-Rovner et al. 1996); and examining the use and effectiveness of decision aids (Stacey et al. 2011), among others. Patients increasingly report a desire to be engaged in their own medical care then they have ever been (Chewning et al. 2012), and shared decision making has become the recommended (though not necessarily implemented) practice for patient-centered care in many prominent medical institutions (Epstein and Peters 2009). However, many questions remain, including how engagement in decision-making may positively or negatively affect patients' satisfaction with their healthcare, choices regarding utilization of healthcare, relationships with their healthcare providers, and health outcomes. Further, additional work is needed to better understand how patients with various conditions and from diverse backgrounds make complex medical decisions. Aligned with the theme of this year’s SfAA Annual Meeting, Continuity and Change, this session explores how our current theoretical and empirical approaches to medical decision-making have illuminated or obscured illness experiences and health outcomes.
Our Paper Abstract:
The role of patients in medical decision-making has become an increasingly important concept in research about healthcare systems, challenging deeply, engrained social expectations structuring the doctor-patient relationship. However, this focus on patient decision-making has been less effective in interrogating the variability in the decision-making process itself and in identifying the impact of this shift in the patient's role on patients' health behaviors and outcomes. Utilizing data from a prospective ethnography of women's breast cancer treatment decision-making and experiences, we seek to challenge key assumptions underlying much of the existing literature in medical decision-making. Specifically, using the case of adjuvant endocrine therapy in the treatment of breast cancer, we argue that in examining the decision-making process, one first must recognize that not all decisions are discrete, one-time events with static outcomes. First, while often described in the literature as a singular decision, in reality a woman's initial decision of whether to take the drug prescribed is followed by the daily decision to continue taking the drug for 5-10 years. Further, once a decision has been "made," literature relying on survey methodology often assumes that cognitive outcomes such as decisional satisfaction or regret reflect relatively static cognitive states. However, our data suggest that patients experience on-going decisional conflict both before and after they start taking (or decline to take) endocrine therapy. Based on these results, we suggest that theoretical and clinical models of the decision-making process need to be tailored to different kinds of decisions and, in the case of ongoing decisions, those models need to frame how to continually monitor and manage the decision.
If you are interested in participating in the panel, please send an abstract to Louise Beryl (firstname.lastname@example.org) by Monday, Oct. 13, 2014