What does shared decision making look like in natural settings? A mixed methods study of patient–provider conversations


  • Joy Lee Indiana University School of Medicine and Regenstrief Institute, Indianapolis
  • Wynne Callon Johns Hopkins University
  • Carlton Haywood, Jr. Johns Hopkins University
  • Sophie M. Lanzkron Johns Hopkins University
  • Pål Gulbrandsen University of Oslo and Akershus University Hospital, Lørenskog
  • Mary Catherine Beach Johns Hopkins University




conversation analysis, patient-provider communication, SDM framework, shared decision making, sickle cell disease


Objective: To understand the variability and nature of shared decision making (SDM) regarding a uniform type of serious medical decision, and to make normative judgments about how these conversations might be improved. Methods: This was a mixed-methods sub-analysis of the Improving Patient Outcomes with Respect and Trust (IMPORT) study. We used the Braddock framework to identify and describe seven elements of SDM in audio-recorded encounters regarding initiation of hydroxyurea, and used data from medical records and patient questionnaires to understand whether and how these tasks were achieved. Results: Physicians covered a spectrum of SDM behaviors: all dialogues contained discussion regarding the clinical issue and the pros and cons of treatment; the patient's understanding and role were not explicitly assessed or stated in any encounter. Yet no patient agreed to start hydroxyurea who did not already prefer it. There was no uniform approach to how physicians presented risk; many concerns expressed by patients in a pre-visit questionnaire were not discussed. Conclusion: In this analysis, patients seemed to understand their role in the decision-making process, suggesting that a patient's role may not always need to be explicitly stated. However, shared decision making might be improved with more routine assessment of patient understanding and concerns. Standardized decision aids might help fully inform patients of risks and benefits.

Author Biographies

Joy Lee, Indiana University School of Medicine and Regenstrief Institute, Indianapolis

Joy Lee received her PhD in Health Services Research and Policy from the Johns Hopkins Bloomberg School of Public Health and is currently an Assistant Professor of Medicine in the Division of General Internal Medicine and Geriatrics at the Indiana University School of Medicine and a Research Scientist at the Regenstrief Institute. Dr. Lee's research focuses on consumer health technology, electronic communication, understanding how electronic health records can be used to improve quality of care, and relationships between patients and clinicians.

Wynne Callon, Johns Hopkins University

Wynne Callon is a third-year medical student at Johns Hopkins University School of Medicine. Her research focuses on the assessment of patient–provider communication content and quality in a variety of pediatric and adult clinical settings.

Carlton Haywood, Jr., Johns Hopkins University

Carlton Haywood Jr received his doctorate in bioethics and health policy from the Johns Hopkins Bloomberg School of Public Health and is currently a core faculty member at the Johns Hopkins Berman Institute of Bioethics. Dr. Haywood conducts empirical bioethics and health services research related to sickle cell diseases.

Sophie M. Lanzkron, Johns Hopkins University

Sophie M. Lanzkron received her MD from the Albert Einstein College of Medicine in 1991 and is currently the Director of the Sickle Cell Center for Adults at Johns Hopkins and Assistant Professor of Medicine and Oncology. Dr. Lanzkron’s major clinical research involves the study of sickle cell disease and understanding the barriers to care for adults with sickle cell disease.

Pål Gulbrandsen, University of Oslo and Akershus University Hospital, Lørenskog

Pål Gulbrandsen received his MD from the University of Bergen and is currently a Professor at the University of Oslo, Institute of Clinical Communication. He has expertise in clinical communication and medical ethics.

Mary Catherine Beach, Johns Hopkins University

Mary Catherine Beach received her MD from theMount Sinai School of Medicine and is currentlya Professor of Medicine in the Johns HopkinsUniversity School of Medicine and the BloombergSchool of Public Health. She conducts research on thetheoretical foundations of respect and the impact ofphysician attitudes and patient–physician communicationon patients.


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How to Cite

Lee, J., Callon, W., Haywood, Jr., C., Lanzkron, S. M., Gulbrandsen, P., & Beach, M. C. (2018). What does shared decision making look like in natural settings? A mixed methods study of patient–provider conversations. Communication and Medicine, 14(3), 217–228. https://doi.org/10.1558/cam.32815




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