title: Temporal characteristics of decisions in hospital encounters: a threshold for shared decision making? A qualitative study.
abstract: OBJECTIVE
  To identify and characterize physicians' statements that contained evidence of clinically relevant decisions in encounters with patients in different hospital settings.
  
  
  METHODS
  Qualitative analysis of 50 videotaped encounters from wards, the emergency room (ER) and outpatient clinics in a department of internal medicine at a Norwegian university hospital.
  
  
  RESULTS
  Clinical decisions could be grouped in a temporal order: decisions which had already been made, and were brought into the encounter by the physician (preformed decisions), decisions made in the present (here-and-now decisions), and decisions prescribing future actions given a certain course of events (conditional decisions). Preformed decisions were a hallmark in the ward and conditional decisions a main feature of ER encounters.
  
  
  CONCLUSIONS
  Clinical decisions related to a patient-physician encounter spanned a time frame exceeding the duration of the encounter. While a distribution of decisions over time and space fosters sharing and dilution of responsibility between providers, it makes the decision making process hard to access for patients.
  
  
  CONCLUSIONS
  In order to plan when and how to involve patients in decisions, physicians need increased awareness of when clinical decisions are made, who usually makes them, and who should make them.
authors.affiliation: The Research Center, Akershus University Hospital, Lorenskog, Norway. Electronic address: eirikofstad@gmail.com.
authors.forename: Eirik H
authors.initials: EH
authors.lastname: Ofstad
authors.affiliation: Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway.
authors.forename: Jan C
authors.initials: JC
authors.lastname: Frich
authors.affiliation: Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway.
authors.forename: Edvin
authors.initials: E
authors.lastname: Schei
authors.affiliation: Indiana University School of Medicine, VA HSR&D Center of Excellence, Roudebush VA Medical Center, Indianapolis, USA.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Frankel
authors.affiliation: Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lorenskog, Norway; The Research Center, Akershus University Hospital, Lorenskog, Norway.
authors.forename: Pål
authors.initials: P
authors.lastname: Gulbrandsen
mesh_terms: D003142:Communication; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D010817:Physician-Patient Relations; D010820:Physicians; D036301:Qualitative Research; D014743:Videotape Recording
keywords: Hospital medicine; Medical decision making; Patient–physician communication; Physician behavior; Shared decision making