title: Making information 'relevant': general practitioner judgments and the production of patient involvement.
abstract: Sociological work that has engaged with the issue of patient involvement in health care suggests it needs to be recognised that decision-making is not simply an individual cognitive act contained in a single consultation, but a process that is distributed across multiple encounters in relation to a range of agents and non-human actors. Drawing on such conceptualisations of decision-making, and based on semi-structured interviews with 24 General Practitioners (GPs) in the United Kingdom about the prescription of statins for the primary prevention of cardiovascular disease, this paper explores the preemptive work that GPs perform when attempting to achieve patient involvement in healthcare decisions. The paper identifies a set of repertoires through which they evaluate and coordinate often contradictory forms of knowledge, transforming them into information that they think is relevant to patients, and which will potentially facilitate meaningful involvement in healthcare decisions. The study concludes by suggesting that such fluid and context sensitive practices are a necessary strategy for navigating complex health environments, which can be justified and underpinned by a relational model of autonomy. However, work needs to be done to explore how such judgments can be calibrated to mesh with the decision-making preferences of patients and what new approaches and standards for practice this would require.
authors.affiliation: University of Cambridge Primary Care Unit, Institute of Public Health, Forvie Site, Robinson Way, Cambridge CB2 0SR, UK. Electronic address: megan.clinch@open.ac.uk.
authors.forename: Megan
authors.initials: M
authors.lastname: Clinch
authors.forename: John
authors.initials: J
authors.lastname: Benson
mesh_terms: D001291:Attitude of Health Personnel; D002318:Cardiovascular Diseases / Q000517:prevention & control; D058005:General Practitioners / Q000523:psychology*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007600:Judgment; D010353:Patient Education as Topic; D010358:Patient Participation; D011322:Primary Prevention; D036301:Qualitative Research; D006113:United Kingdom
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Cardiovascular diseases; Decision-making; Patient-centred care; Physician–patient relations; Primary prevention; United Kingdom