Navigating the Decision Space: Shared Medical Decision Making as Distributed Cognition. (June 2017)

• Record Type: Journal Article
• Authors: Lippa, Katherine D.; Feufel, Markus A.; Robinson, F. Eric; Shalin, Valerie L.
• Is Part Of: Qualitative health research. Volume 27:Number 7(2017)
• Page Start: 1035
• Page End: 1048
• Publication Date: 2017-06
• Subjects: doctor–patient communication and relations -- cognition -- decision making -- chronic disease -- Multiple Sclerosis -- emergency care -- qualitative -- grounded theory -- North America; Health -- Periodicals; Health behavior -- Periodicals; Health -- Research -- Methodology -- Periodicals; Health behavior -- Research -- Methodology -- Periodicals; 610.7205
• DOI: 10.1177/1049732316665347
• Languages: English
• ISSNs: 1049-7323

Abstract

Despite increasing prominence, little is known about the cognitive processes underlying shared decision making. To investigate these processes, we conceptualize shared decision making as a form of distributed cognition. We introduce a Decision Space Model to identify physical and social influences on decision making. Using field observations and interviews, we demonstrate that patients and physicians in both acute and chronic care consider these influences when identifying the need for a decision, searching for decision parameters, making actionable decisions Based on the distribution of access to information and actions, we then identify four related patterns: physician dominated; physician-defined, patient-made; patient-defined, physician-made; and patient-dominated decisions. Results suggests that (a) decision making is necessarily distributed between physicians and patients, (b) differential access to information and action over time requires participants to transform a distributed task into a shared decision, and (c) adverse outcomes may result from failures to integrate physician and patient reasoning. Our analysis unifies disparate findings in the medical decision-making literature and has implications for improving care and medical training.