The Article in Brief

Shared Decision Making and the Experience of Partnership in Primary Care

George W. Saba, PhD , and colleagues

Background The goal of this study is to learn more about shared decision making, in which patients and physicians make decisions after openly exchanging information and exploring beliefs. The study looks at how the communication behavior of shared decision making is related to patients’ and physicians’ experience of partnership. The study also tests new research strategies for understanding the relationship between communication skills and personal experience.

What This Study Found Communication behavior and relationship factors influence personal experiences of partnership between patients and doctors. In many (41%) of the decision moments, there was agreement between participants’ perception and the study’s ratings of shared decision making. But for most (59%) decision moments, communication behaviors and personal experience were not aligned. In 38% of decision moments, patients and physicians exchanged information and beliefs and appeared to make joint decisions; however, their relationship was characterized by mistrust, withholding of crucial information, or mutual frustration. In 21% of decision moments, patients and physicians collaborated in decision making despite a limited amount of clear communication.

Implications

• Communication is more complex than a set of communication behaviors.
• Shared decision making can appear successful, but when the process is not truly collaborative, important information can be withheld, and participants may have different intentions about a care plan.
• Efforts to strengthen patient-physician communication, especially among disadvantaged populations, must focus on both communication behavior and personal interactions.