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When patients and clinician (dis)agree about the nature of the problem: The role of displays of shared understanding in acceptance of treatment

McCabe, R. ORCID: 0000-0003-2041-7383 (2021). When patients and clinician (dis)agree about the nature of the problem: The role of displays of shared understanding in acceptance of treatment. Social Science & Medicine, 114208. doi: 10.1016/j.socscimed.2021.114208


Globally, 4.4% of the world's population suffer from depressive disorder, and 3.6% from anxiety disorder. Previous work found considerable negotiation between providers and patients about the nature of mental health problems and frequent patient resistance to treatment. However, how doctor-patient shared understanding of the problem is reflected in treatment recommendations and whether this is consequential for patient acceptance of treatment is poorly understood. This study explored shared understanding of the problem and patient acceptance of treatment using conversation analysis. In 52 U.K. video recorded primary care consultations (collected July 2014–April 2015), 33 treatment recommendations for medication or talking therapy were identified. Shared understanding was explored focusing on: whether the patient presented the mental health problem as their primary initial concern and how they characterised the concern; whether the mental health concern was raised by the patient; and how the doctor aligned with the patient's earlier characterisation of the problem in the treatment recommendation itself. These phenomena were coded for each treatment recommendation and the impact on treatment acceptance was explored. Patients accepted the recommendation immediately in 38% cases and actively resisted in 62% cases. However, two communication behaviors were associated with patient acceptance: recommending treatment for the patient's initial focal concern and doctors' turn design in the recommendation itself, i.e., using the patient's earlier words from the initial problem presentation to describe and characterise the problem. Given the global burden of mental health problems and frequent patient resistance to treatment, understanding how professionals can engage more closely with the patient's perspective is important. When doctors use the patient's precise words from the initial problem presentation in the treatment recommendation, this displays an understanding of the patient's perspective and personalisation of treatment based on the underlying biomedical or social causes, which then impacts on patient acceptance of treatment.

Publication Type: Article
Additional Information: © 2021. This manuscript version is made available under the CC-BY-NC-ND 4.0 license
Publisher Keywords: Communication, Conversation analysis, Shared understanding, Mental health, Patient acceptance, Patient resistance
Subjects: H Social Sciences > HM Sociology
R Medicine > RA Public aspects of medicine
Departments: School of Health Sciences > Healthcare Services Research & Management
Date available in CRO: 03 Aug 2021 11:22
Date deposited: 3 August 2021
Date of acceptance: 30 June 2021
Date of first online publication: 7 July 2021
[img] Text - Accepted Version
This document is not freely accessible until 7 July 2022 due to copyright restrictions.
Available under License Creative Commons Attribution Non-commercial No Derivatives.

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