Year: 2015
Type: dissertation
Abstract: Decision-making is a key activity in health care and clinical decisions are important outcomes of patient-physician encounters. We wanted to study how the dialogue between physician and patient influences decisions about diagnostic procedures and treatment in hospital encounters with patients. Previous studies describing the nature and frequencies of clinical decisions in patient-physician encounters have focused on the degree of patient involvement in the decision-making process. We realized such an approach to clinical decisions might exclude other clinically relevant decisions that are made in medical encounters. \n \nBecause of this we aimed to describe clinically relevant decisions as they emerge in patient-physician dialogue in a precise, detailed and comprehensive manner. We conducted a qualitative study based on 380 patient-physician encounters from 17 different specialties videotaped at Akershus University Hospital in 2007-2008. Through a content-driven, iterative process involving the perspectives of four physicians we found that clinically relevant decisions in medical encounters comprise more than what has previously been framed as decisions, which called for a broader definition and classification of the term. \n \nWe have developed a taxonomy consisting of ten topical categories and three temporal categories allowing identification and classification by defining a clinically relevant decision as “a verbal statement committing to a particular course of clinically relevant action and/or statement concerning the patient’s health that carries meaning and weight because it is said by a medical expert”. The taxonomy is named The Decision Identification and Classification Taxonomy for Use in Medicine (DICTUM). Applying DICTUM to our material led us to find an average of 13 clinically relevant decisions in 372 hospital encounters. Content coding of our material has provided a description of clinically relevant decisions across different clinical specialties, settings, physicians and encounters. \n \nWe think that DICTUM could prove helpful in other descriptive studies of clinical decision-making and aid future studies aiming to assess the quality of medical decisions with regards to level of patient involvement, patient safety, provider professionalism and degree of concordance with evidence based practice.
Author: Eirik Hugaas Ofstad
Language: English
Subfield: General Health Professions
Field: Health Professions
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2285504680