Case study

Patient choice in practice: improving communication in healthcare consultations

Our insights from conversation analysis have helped doctors, nurses and medical students support patients in making choices about their treatment in the NHS and across the world.

a doctor and patient discussing a medical issue

The issue

Shared decision-making is a widespread ideal across the National Health Service (NHS) in Great Britain and in many other healthcare settings. But studies repeatedly show that doctors and nurses struggle to enact this ideal in practice.

This matters because patients report wanting to be more involved in deciding about their care and there is good evidence that they do better when they are. Better communication skills are key. However, conventional training has been criticised - by medics themselves - for not being specific enough to equip them for the complexities of real conversations with patients.

The research

Communication has been a focus of research in Sociology at York for over four decades. A recent project, externally funded by the NIHR, explored how doctors made decisions with patients in over 200 real-time neurology consultations. 

We identified two effective ways in which doctors offered patients a choice.  However, we found that doctors were much more likely to make recommendations for what they thought was best.  When they did so, patients were significantly more likely to end up accepting the recommended course of action than when a choice was offered.  This implies a dilemma for doctors: on the one hand, NHS policy has emphasised the need to increase patient choice since at least 2000; on the other hand, clinical guidelines may show that one treatment is best. 

We argue that doctors need to be aware of the advantages and risks of different approaches to decision-making in order to balance their duty of care with their responsibility to empower patients to make their own decisions.  

The outcome

Making decisions with patients is not easy. Doctors and nurses benefit from specific communication training, grounded in how decision-making works in practice. Our research identified effective communication skills and produced a rich evidence base of recorded consultations. We have used this to produce innovative in-person and online training for medical staff and students. This has reached across numerous medical specialties in the NHS and in Brazil, the Netherlands and Norway. Our findings have been included in medical school curricula and by the UK’s National Institute for Health and Care Excellence (NICE) in their training on how to implement shared decision-making.

Related research in the Sociology Department on decision-making in midwife-led maternity units also shows that policy initiatives emphasising patient involvement are challenging to enact in practice. It has found that women are afforded limited optionality in decision-making, and that midwives orient to guidelines/standard clinical practice in pursuing particular decisional outcomes. We are currently working with the Royal College of Midwives’ Progress Theatre Group to disseminate these findings.

For more about our research on patient choice in practice, see:   

Featured researcher

Merran Toerien

Professor Toerien's primary research interest is the application of conversation analysis to the study of talk in institutional settings.

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Featured researcher

Clare Jackson

Dr Jackson has research interests in gender and sexuality, social psychology and conversation analysis.

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Featured researcher

Ellen Annandale

Professor Annandale's main research interests lie in the sociology of health and illness and the sociology of gender and the connections between these two fields.

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Featured researcher

Sian Beynon-Jones

Dr Beynon-Jones's current research focuses on the forms of temporality that we live with and how available forms of ‘time’ are produced through technoscientific practices, and their regulation.

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