title: Navigating the Decision Space: Shared Medical Decision Making as Distributed Cognition.
abstract: Despite increasing prominence, little is known about the cognitive processes underlying shared decision making. To investigate these processes, we conceptualize shared decision making as a form of distributed cognition. We introduce a Decision Space Model to identify physical and social influences on decision making. Using field observations and interviews, we demonstrate that patients and physicians in both acute and chronic care consider these influences when identifying the need for a decision, searching for decision parameters, making actionable decisions Based on the distribution of access to information and actions, we then identify four related patterns: physician dominated; physician-defined, patient-made; patient-defined, physician-made; and patient-dominated decisions. Results suggests that (a) decision making is necessarily distributed between physicians and patients, (b) differential access to information and action over time requires participants to transform a distributed task into a shared decision, and (c) adverse outcomes may result from failures to integrate physician and patient reasoning. Our analysis unifies disparate findings in the medical decision-making literature and has implications for improving care and medical training.
authors.affiliation: 1 Wright State University, Dayton, Ohio, USA.
authors.forename: Katherine D
authors.initials: KD
authors.lastname: Lippa
authors.affiliation: 2 Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Markus A
authors.initials: MA
authors.lastname: Feufel
authors.affiliation: 1 Wright State University, Dayton, Ohio, USA.
authors.forename: F Eric
authors.initials: FE
authors.lastname: Robinson
authors.affiliation: 1 Wright State University, Dayton, Ohio, USA.
authors.forename: Valerie L
authors.initials: VL
authors.lastname: Shalin
mesh_terms: D000208:Acute Disease; D001291:Attitude of Health Personnel; D002908:Chronic Disease; D000066491:Clinical Decision-Making / Q000379:methods*; D003071:Cognition; D003142:Communication; D006801:Humans; D010358:Patient Participation / Q000523:psychology*; D010817:Physician-Patient Relations; D011582:Psychological Theory; D036301:Qualitative Research
keywords: Multiple Sclerosis; North America; chronic disease; cognition; decision making; doctor–patient communication and relations; emergency care; grounded theory; qualitative