Explorative observational study of Dutch patient-clinician interactions: operationalisation of personal perspective elicitation as part of shared decision-making in real-life audio-recorded consultations.

Patients' preferences, values and contexts are important elements of the shared decision-making (SDM) process. We captured those elements into the concept of 'personal perspective elicitation' (PPE), which reflects the need to elicit patients' preferences, values and contexts in patient-clinician conversations. We defined PPE as: 'the disclosure (either elicited by the clinician or spontaneously expressed by the patient) of information related to the patient's personal preferences, values and/or contexts potentially relevant to decision-making'. Our goal was to operationalise the concept of PPE through the evaluation of preferences, values and contexts and explore how PPE occurs in clinical encounters. Cross-sectional study: observational coding based on a novel coding scheme of audio-recorded outpatient clinical encounters where encounter patient decision aids were applied. We audio-recorded patient-clinician interactions at three Dutch outpatient clinics. PPE was analysed using a novel observational coding scheme, distinguishing preferences, contexts and four Armstrong taxonomy value types (global, decisional, external and situational). We measured SDM using the Observer OPTION Twenty patients who suffered from psoriasis or ovarian cysts; four clinicians. We included 20 audio-recordings. The mean Observer OPTION The operationalisation of PPE, an important aspect of SDM, explores which preferences, values and contexts were discussed during patient-clinician interactions where an ePDA was used. The coding scheme appeared feasible to apply but needs further refinement.

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Competing interests: GE has edited and published books that provide royalties: Shared Decision Making (Oxford University Press) and Groups (Radcliffe Press). Glyn Elwyn’s academic interests are focused on shared decision-making and coproduction. He owns copyright in measures of shared decision-making (collaboRATE) and care integration (integRATE), a measure of experience of care in serious illness (consideRATE), a measure of goal setting coopeRATE, a measure of clinician willingness to do shared decision-making (incorpoRATE), an observer measures of shared decision-making (Observer OPTION-5 and Observer OPTION-12). He is the Founder and Director of &think LLC which owns the registered trademark for Option GridsTM patient decision aids; Founder, Director of SHARPNETWORK LLC, a provider of online training for shared decision-making, consultant to EBSCO Health and Chief Clinical Research Scientist to abridge AI Inc. JAMK is Special Envoy for Appropriate Care (Ministry of Health, the Netherlands). DD is a member of the programme committee of ZonMw. ZonMw programmes and funds research and innovation in health, healthcare and well-being, encourages the use of this knowledge and highlights knowledge needs. JWMA, Guus Brand, Marjan Meinders and Ester Rake: none declared.