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Patient Educ Couns. 2014 Nov;97(2):158-64. doi: 10.1016/j.pec.2014.07.027. Epub 2014 Aug 13.

Collaborative deliberation: a model for patient care.

Author information

1
The Dartmouth Center for Health Care Delivery Science, Dartmouth College, USA. Electronic address: glynelwyn@gmail.com.
2
Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, UK.
3
Faculty of Health Sciences, University of Southampton, UK.
4
School Caphri, Department of Family Medicine, Maastricht University, The Netherlands.
5
Department of Medical Decision Making, Leiden University, The Netherlands.
6
Gordon and Betty Moore Foundation, USA; Department of Medicine, The University of California, Los Angeles, USA; Palo Alto Medical Foundation Research Institute, USA.
7
Institute of Health & Society, Newcastle University, UK.
8
The Dartmouth Center for Health Care Delivery Science, Dartmouth College, USA.
9
Health Care Delivery Research Program, Mayo Clinic Center for the Science of Health Care Delivery, Mayo Clinic, USA.
10
Center for Communication and Disparities Research, Department of Family Medicine, University of Rochester, USA.

Abstract

OBJECTIVE:

Existing theoretical work in decision making and behavior change has focused on how individuals arrive at decisions or form intentions. Less attention has been given to theorizing the requirements that might be necessary for individuals to work collaboratively to address difficult decisions, consider new alternatives, or change behaviors. The goal of this work was to develop, as a forerunner to a middle range theory, a conceptual model that considers the process of supporting patients to consider alternative health care options, in collaboration with clinicians, and others.

METHODS:

Theory building among researchers with experience and expertise in clinician-patient communication, using an iterative cycle of discussions.

RESULTS:

We developed a model composed of five inter-related propositions that serve as a foundation for clinical communication processes that honor the ethical principles of respecting individual agency, autonomy, and an empathic approach to practice. We named the model 'collaborative deliberation.' The propositions describe: (1) constructive interpersonal engagement, (2) recognition of alternative actions, (3) comparative learning, (4) preference construction and elicitation, and (5) preference integration.

CONCLUSIONS:

We believe the model underpins multiple suggested approaches to clinical practice that take the form of patient centered care, motivational interviewing, goal setting, action planning, and shared decision making.

KEYWORDS:

Behavior change; Motivational interviewing; Patient centered care; Patient–clinician communication; Shared decision making

Comment in

PMID:
25175366
DOI:
10.1016/j.pec.2014.07.027
[Indexed for MEDLINE]

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