An absence of equipoise: Examining surgeons' decision talk during encounters with women considering breast cancer surgery.
Shared decision-making is recommended for decisions with multiple reasonable options, yet clinicians often subtly or explicitly guide choices. Using purposive sampling, we performed a secondary analysis of 142 audio-recorded encounters between 13 surgeons and women eligible for breast-conserving sur...
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2021-01-01
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| Series: | PLoS ONE |
| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0260704&type=printable |
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| author | Mary C Politi Catherine H Saunders Victoria F Grabinski Renata W Yen Amy E Cyr Marie-Anne Durand Glyn Elwyn |
| author_facet | Mary C Politi Catherine H Saunders Victoria F Grabinski Renata W Yen Amy E Cyr Marie-Anne Durand Glyn Elwyn |
| author_sort | Mary C Politi |
| collection | DOAJ |
| description | Shared decision-making is recommended for decisions with multiple reasonable options, yet clinicians often subtly or explicitly guide choices. Using purposive sampling, we performed a secondary analysis of 142 audio-recorded encounters between 13 surgeons and women eligible for breast-conserving surgery with radiation or mastectomy. We trained 9 surgeons in shared decision-making and provided them one of two conversation aids; 4 surgeons practiced as usual. Based on a published taxonomy of treatment recommendations (pronouncements, suggestions, proposals, offers, assertions), we examined how surgeons framed choices with patients. Many surgeons made assertions providing information and advice (usual care 71% vs. intervention 66%; p = 0.54). Some made strong pronouncements (usual care 51% vs. intervention 36%; p = .09). Few made proposals and offers, leaving the door open for deliberation (proposals usual care 21% vs. intervention 26%; p = 0.51; offers usual care 40% vs. intervention 40%; p = 0.98). Surgeons were significantly more likely to describe options as comparable when using a conversation aid, mentioning this in all intervention group encounters (usual care 64% vs. intervention 100%; p<0.001). Conversation aids can facilitate offers of comparable options, but other conversational actions can inhibit aspects of shared decision-making. |
| format | Article |
| id | doaj-art-43fb2be3846d42709ed8d7ce0c26a79a |
| institution | DOAJ |
| issn | 1932-6203 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj-art-43fb2be3846d42709ed8d7ce0c26a79a2025-08-20T03:00:05ZengPublic Library of Science (PLoS)PLoS ONE1932-62032021-01-011612e026070410.1371/journal.pone.0260704An absence of equipoise: Examining surgeons' decision talk during encounters with women considering breast cancer surgery.Mary C PolitiCatherine H SaundersVictoria F GrabinskiRenata W YenAmy E CyrMarie-Anne DurandGlyn ElwynShared decision-making is recommended for decisions with multiple reasonable options, yet clinicians often subtly or explicitly guide choices. Using purposive sampling, we performed a secondary analysis of 142 audio-recorded encounters between 13 surgeons and women eligible for breast-conserving surgery with radiation or mastectomy. We trained 9 surgeons in shared decision-making and provided them one of two conversation aids; 4 surgeons practiced as usual. Based on a published taxonomy of treatment recommendations (pronouncements, suggestions, proposals, offers, assertions), we examined how surgeons framed choices with patients. Many surgeons made assertions providing information and advice (usual care 71% vs. intervention 66%; p = 0.54). Some made strong pronouncements (usual care 51% vs. intervention 36%; p = .09). Few made proposals and offers, leaving the door open for deliberation (proposals usual care 21% vs. intervention 26%; p = 0.51; offers usual care 40% vs. intervention 40%; p = 0.98). Surgeons were significantly more likely to describe options as comparable when using a conversation aid, mentioning this in all intervention group encounters (usual care 64% vs. intervention 100%; p<0.001). Conversation aids can facilitate offers of comparable options, but other conversational actions can inhibit aspects of shared decision-making.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0260704&type=printable |
| spellingShingle | Mary C Politi Catherine H Saunders Victoria F Grabinski Renata W Yen Amy E Cyr Marie-Anne Durand Glyn Elwyn An absence of equipoise: Examining surgeons' decision talk during encounters with women considering breast cancer surgery. PLoS ONE |
| title | An absence of equipoise: Examining surgeons' decision talk during encounters with women considering breast cancer surgery. |
| title_full | An absence of equipoise: Examining surgeons' decision talk during encounters with women considering breast cancer surgery. |
| title_fullStr | An absence of equipoise: Examining surgeons' decision talk during encounters with women considering breast cancer surgery. |
| title_full_unstemmed | An absence of equipoise: Examining surgeons' decision talk during encounters with women considering breast cancer surgery. |
| title_short | An absence of equipoise: Examining surgeons' decision talk during encounters with women considering breast cancer surgery. |
| title_sort | absence of equipoise examining surgeons decision talk during encounters with women considering breast cancer surgery |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0260704&type=printable |
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