The experience of shared decision-making for breast cancer: a qualitative study

Shared decision making (SDM) is a collaborative process that allows patients and their providers to make health care decisions together, taking into account scientific evidence and the patient’s values and preferences. The thesis shifts the explanatory framework of SDM from current literature, which evaluates the concept of SDM, to a qualitative critical health psychology approach, which explores SDM in terms of its meaning and experiences for individuals. The thesis explores the experience of SDM for the treatment of breast cancer, and theoretically draws on phenomenology (Husserl, 1970) and symbolic interactionism (Blumer, 1969). The thesis comprises three separate studies to investigate patient experiences of SDM, based on a triangulation of in-depth qualitative methods, which explore patient perceptions and interactions. Study one, a semi-structured interview design with post-treatment patients, identifies themes in accounts of SDM by means of a thematic analysis. Study two, explores SDM further through a thematic analysis on patient interaction within Internet breast cancer support forums. Study three, discusses the experience of SDM through a conversation analysis on doctor-patient interaction during adjuvant treatment consultations. Results indicate that for most patients, SDM is understood in accordance with the NICE guidelines (2004 & 2012), and is experienced through the characteristics of two-way interaction, information exchange (‘sharing information’), and sharing of views and preferences (‘sharing decisions’), in respect to individual differences. SDM is also experienced during online interaction. The forums make patients aware of SDM, and encourage it to occur during consultations. However, the construction of power, as a clinical problem, results in problematic experiences of SDM. A perceived discrepancy in clinician-patient roles and discursive practices creates an issue of unbalanced doctor-patient power-relations. This deters patient participation and patients’ recognition and response to SDM. The research contributes to qualitative research and critical health psychology. It has implications for medical professionals to understand patient experience of SDM, and to improve doctor-patient communication skills for SDM, for the development of breast cancer services to promote patient good health and well-being