Navigating Challenges in Shared Decision-Making in Danish Patient Care
DOI:
https://doi.org/10.7577/pp.6052Abstract
Patient-centered care and patient choice are reshaping management practices in the Danish public healthcare sector. Patients are becoming more involved in their treatment and assuming greater control over their healthcare decisions. This transformation redefines relationships among patients, professionals, and the state. It raises important inquiries into how healthcare professionals navigate their new roles and responsibilities within this changing landscape. In this paper, we interviewed ten health professionals to delineate how they handle user involvement in daily clinical practice. Utilizing a sociology of profession framework for thematic analysis, our research revealed the disparities between the ideal and the actual implementation of patient-centered care. It highlighted the challenges healthcare professionals encounter in integrating shared decision-making practices and ensuring patients are adequately informed. We conclude that uncertainties regarding responsibility allocation and the boundaries of healthcare professional involvement often overshadow shared responsibility between healthcare professionals and patients.
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Abbott, A. (1988). The system of professions: An essay on the division of expert labor. University of Chicago Press. https://doi.org/10.7208/chicago/9780226189666.001.0001
Anderson, L., Spanjol, J., Jefferies, J. G., Ostrom, A. L., Nations Baker, C., Bone, S. A., Downey, H., Mende, M., & Rapp, J. M. (2016). Responsibility and well-being: Resource integration under responsibilization in expert services. Journal of Public Policy & Marketing, 35(2), 262–279. https://doi.org/10.1509/jppm.15.140
Bourdieu, P. (1990). The logic of practice. Stanford University Press. https://doi.org/10.1515/9781503621749
Childress, J. F., & Childress, M. D. (2020). What does the evolution from informed consent to shared decision making teach us about authority in health care? AMA J Ethics, 22(5), E423–429. https://doi.org/10.1001/amajethics.2020.423
Chinn, D. (2011). Critical health literacy: A review and critical analysis. Social Science & Medicine, 73(1), 60–67. https://doi.org/https://doi.org/10.1016/j.socscimed.2011.04.004
Dent, M. (2006). Patient choice and medicine in health care: Responsibilization, governance and proto-professionalization. Public Management Review, 8(3), 449–462. https://doi.org/10.1080/14719030600853360
Dent, M., Fallon, C., Wendt, C., Vuori, J., Pahor, M., de Pietro, C., & Silva, S. (2011). Medicine and user involvement within European healthcare: A typology for European comparative research. International Journal of Clinical Practice, 65(12), 1218–1220. https://doi.org/10.1111/j.1742-1241.2011.02803.x
Dent, M., & Pahor, M. (2015). Patient involvement in Europe—a comparative framework. Journal of Health Organization and Management, 29(5), 546–555. https://doi.org/10.1108/JHOM-05-2015-0078
De Swaan, A. (1988). In Care of the State. Polity Press.
Edwards, A., & Elwyn, G. (2006). Inside the black box of shared decision making: distinguishing between the process of involvement and who makes the decision. Health Expectations, 9(4), 307–320. https://doi.org/10.1111/j.1369-7625.2006.00401.x
Edwards, A., & Elwyn, G. (2009). Shared decision-making in health care: Achieving evidence-based patient choice. Oxford University Press. https://doi.org/10.1093/oso/9780199546275.003.0001
Elster, J. (1998). Introduction. In J. Elster (Ed.), Deliberative Democracy (pp.1-18). Cambridge University Press.
Franklin, M., Lewis, S., Willis, K., Rogers, A., Venville, A., & Smith, L. (2019). Controlled, constrained, or flexible? How self-management goals are shaped by patient-provider interactions. Qualitative Health Research, 29(4), 557–567. https://doi.org/10.1177/1049732318774324
Freidson, E. (1988). Profession of medicine: A study of the sociology of applied knowledge. University of Chicago Press.
Frosch, D. L., & Kaplan, R. M. (1999). Shared decision making in clinical medicine: Past research and future directions. American Journal of Preventive Medicine, 17(4), 285–294. https://doi.org/10.1016/S0749-3797(99)00097-5
Garfinkel, H. (2023). Studies in ethnomethodology. In W. Longhofer & D. Winchester (Eds.), Social theory re-wired (pp. 58–66). Routledge. https://doi.org/10.4324/9781003320609-8
Hindhede, A. L., & Larsen, K. (2018). Prestige hierarchies of diseases and specialities in a field perspective. Social Theory & Health, 17, 1–18. https://doi.org/10.1057/s41285-018-0074-5
Holmes‐Rovner, M., Valade, D., Orlowski, C., Draus, C., Nabozny‐Valerio, B., & Keiser, S. (2000). Implementing shared decision‐making in routine practice: Barriers and opportunities. Health Expectations, 3(3), 182–191. https://doi.org/10.1046/j.1369-6513.2000.00093.x
Jensen, L. B. S., Larsen, K., & Konradsen, H. (2016). Maintaining a distinction between possible and impossible topics of conversation in the outpatient respiratory medical clinic. Global Qualitative Nursing Research, 3, 2333393616638977. https://doi.org/10.1177/2333393616638977
Kelley, M. (2005). Limits on patient responsibility. The Journal of Medicine and Philosophy, 30(2), 189–206. https://doi.org/10.1080/03605310590926858
Kirkpatrick, I., Dent, M., & Jespersen, P. K. (2011). The contested terrain of hospital management: Professional projects and healthcare reforms in Denmark. Current Sociology, 59(4), 489–506. https://doi.org/10.1177/0011392111402718
Lehane, E., & McCarthy, G. (2007). Intentional and unintentional medication non-adherence: A comprehensive framework for clinical research and practice? A discussion paper. International Journal of Nursing Studies, 44(8), 1468–1477. https://doi.org/10.1016/j.ijnurstu.2006.07.010
Náfrádi, L., Nakamoto, K., & Schulz, P. J. (2017). Is patient empowerment the key to promote adherence? A systematic review of the relationship between self-efficacy, health locus of control and medication adherence. PLOS ONE, 12(10), e0186458. https://doi.org/10.1371/journal.pone.0186458
Newman, J. (2001). Modernising Governance: New Labour, Policy and Society. Sage.
Rose, A., Rosewilliam, S., & Soundy, A. (2017). Shared decision making within goal setting in rehabilitation settings: A systematic review. Patient Education and Counseling, 100(1), 65–75. https://doi.org/10.1016/j.pec.2016.07.030
Rose, N. (1996). Power and subjectivity: Critical history and psychology. In C. F. Graumann & K. J. Gergen (Eds.), Historical dimensions of psychological discourse (pp. 103–124). Cambridge University Press. https://doi.org/10.1017/CBO9780511571329.006
Safaei, J. (2015). Deliberative democracy in health care: Current challenges and future prospects. Journal of Healthcare Leadership, 7, 123–136. https://doi.org/10.2147/jhl.S70021
Sandman, L., & Munthe, C. (2009). Shared decision-making and patient autonomy. Theoretical Medicine and Bioethics, 30(4), 289–310. https://doi.org/10.1007/s11017-009-9114-4
Say, R., Murtagh, M., & Thomson, R. (2006). Patients’ preference for involvement in medical decision making: A narrative review. Patient Education and Counseling, 60(2), 102–114. https://doi.org/10.1016/j.pec.2005.02.003
Schulz, P. J., & Nakamoto, K. (2013). Health literacy and patient empowerment in health communication: The importance of separating conjoined twins. Patient Education and Counseling, 90(1), 4–11. https://doi.org/https://doi.org/10.1016/j.pec.2012.09.006
Sjöberg, V., & Forsner, M. (2022). Shifting roles: Physiotherapists’ perception of person-centered care during a pre-implementation phase in the acute hospital setting—A phenomenographic study. Physiotherapy Theory and Practice, 38(7), 879–889. https://doi.org/10.1080/09593985.2020.1809042
Slim, K., & Bazin, J. E. (2019). From informed consent to shared decision-making in surgery. Journal of Visceral Surgery, 156(3), 181–184. https://doi.org/10.1016/j.jviscsurg.2019.04.014
Sundhedsloven [Health act]. (2024). Bekendtgørelse af sundhedsloven [Promulgation of the health act] (LBK nr 1015 af 05/09/2024). Retsinformation. https://www.retsinformation.dk/eli/lta/2024/1015
Timmermans, S., & Tavory, I. (2012). Theory construction in qualitative research: From grounded theory to abductive analysis. Sociological Theory, 30(3), 167–186. https://doi.org/10.1177/0735275112457914
Vrangbæk, K. (2015). Patient involvement in Danish health care. Journal of Health Organization and Management, 29(5), 611–624. https://doi.org/10.1108/JHOM-01-2015-0002
Vrangbæk, K. (2018). The regulation of health care in Scandinavia: Professionals, the public interest and trust. In J. M. Chamberlain, M. Dent, & M. Saks (Eds.) Professional health regulation in the public interest (pp. 61–76). Policy Press. https://doi.org/10.2307/j.ctv1xxs5q.10
Whitney, S. N., McGuire, A. L., & McCullough, L. B. (2004). A typology of shared decision making, informed consent, and simple consent. Annals of Internal Medicine, 140(1), 54–59. https://doi.org/10.7326/0003-4819-140-1-200401060-00012
World Medical Association (2013). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310(20), 2191–2194. https://doi.org/10.1001/jama.2013.281053
Wroe, A. L. (2002). Intentional and unintentional nonadherence: A study of decision making. Journal of Behavioral Medicine, 25, 355–372. https://doi.org/10.1023/A:1015866415552
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