No description available.

No description available.

No description available.

BACKGROUND.  Shared decision-making is one widely cited model of patients’ participation in decision-making about their own healthcare.  This study aimed to deepen our understanding of the concept of shared decision-making, as it was defined by Charles et al, when two situations arose in consultations:  when information was not exchanged, and when third parties were involved. RESULTS AND DISCUSSION.  For a range of reasons, there were occasions when information was not exchanged, by patients and health professionals, about the patients’ problem or about treatment options.  No consistent relationship between the information not exchanged and patients’ satisfaction with the information given and/or the option selected could be identified.  The addition of a problem definition stage to the model is proposed and some amendments to the model are suggested to compensate for situational factors that may be important in deciding if all information relevant to decision-making has been exchanged. Four types of third party were involved in consultations in various ways and for various reasons.  When third parties were involved, each stage of the decision-making process could look different from the dyadic conceptualisation, e.g. information could flow in various directions and the deliberation could involve coalition formation.  Furthermore, the amount of information exchanged could be hindered or encouraged.  If third parties were involved in consultations the process decision-making may look different from the dyadic conceptualisation.  Although looking different, the decision-making process may still be C-SDM but it may be masked by additional clutter and/or the notion of sharing a decision may be different. CONCLUSIONS.  The concept of C-SDM may be considerably more complex than the current theoretical portrayal in the literature.  Some additions and amendments to the representation of C-SDM are proposed and these may make C-SDM (even more) difficult to implement, teach and measure in practice.

No description available.

No description available.

This study was conceived against the backdrop of academic and medically based discussions about inappropriate use of General Practice, in the context of an overburdened and under resourced National Health Service. Both frequent and less frequent consulters prioritised dilemmas around functional ability, reporting attempts to control illness, and resist loss of normal life and familiar selves. Despite our attempts to sample frequent and less frequent users with similar levels of morbidity in the more detailed qualitative interviews the frequent consulters conveyed more severe illness, which limited their lives and challenged their coherent and moral identities. Cultural, structural and social factors combined to influence health actions; personal troubles were linked to public matters. The accounts revealed how the severity of condition combined with social position influenced the place of the GP consultation in overall management strategies. Women and men communicated common problems, but also discussed experiences which were related to their traditional family roles. Housing status was not revealed as significant, in the context of a complex combination of micro and macro influences on experience. In the frequent consulters’ accounts the role of the GP was magnified in lives diminished and disrupted by chronic illness, whereas the less frequent consulters’ accounts presented a more peripheral role for their GP. Using Bourdieu’s central concepts, the GP was conceptualised as a ‘dispenser of capital’. Throughout, all of the participants described the hard work of illness management, and they used the accounts to display their moral competence. The medical encounter was conveyed against a moral backdrop, and this may have had implications for frequency of consulting. Overall, the symbolic and physical burden of chronic illness was highlighted.