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

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

The ‘credibility paradox’ in China’s science communication: Views from scientific practitioners

In contrast to increasing debates on China’s rising status as a global scientific power, issues of China’s science communication remain under-explored. Based on 21 in-depth interviews in three cities, this article examines Chinese scientists’ accounts of the entangled web of influence which conditions the process of how scientific knowledge achieves (or fails to achieve) its civic authority. A main finding of this study is a ‘credibility paradox’ as a result of the over-politicisation of science and science communication in China. Respondents report that an absence of visible institutional endorsements renders them more public credibility and better communication outcomes. Thus, instead of exploiting formal channels of science communication, scientists interviewed were more keen to act as ‘informal risk communicators’ in grassroots and private events. Chinese scientists’ perspectives on how to earn public support of their research sheds light on the nature and impact of a ‘civic epistemology’ in an authoritarian state

Public values for energy futures: Framing, indeterminacy and policy making

PublishedJournal ArticleCopyright © 2015 Elsevier. NOTICE: this is the author’s version of a work that was accepted for publication in Energy Policy. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Energy Policy (2015), DOI: 10.1016/j.enpol.2015.01.035© 2015 Elsevier Ltd. In the UK there are strong policy imperatives to transition toward low carbon energy systems but how and in what ways such transitional processes might be realised remains highly uncertain. One key area of uncertainty pertains to public attitudes and acceptability. Though there is wide-ranging research relevant to public acceptability, very little work has unpacked the multiple questions concerning how policy-makers can grapple with and mitigate related uncertainties in efforts to enact energy systems change. In this paper, public acceptability is identified as an indeterminate form of uncertainty that presents particular challenges for policy making. We build on our existing research into public values for energy system change to explore how the outcomes of the project can be applied in thinking through the uncertainties associated with public acceptability. Notably, we illustrate how the public values identified through our research bring into view alternative and quite different problem and solution framings to those currently evident within UK policy. We argue that engagement with a wide range of different framings can offer a basis for better understanding and anticipating public responses to energy system change, ultimately aiding in managing the complex set of uncertainties associated with public acceptability.Natural Environment Research CouncilLeverhulme Trus

Black-boxing Sustainable Development: Environmental Impact Assessment on the River Uruguay

International audienceThis chapter offers an original account of Environmental Impact Assessment (EIA) as a technology that scripts collective action through black-boxing the politics of governance. After tracing the global trajectory of the instrument, the chapter looks at EIA struggles in the case of pulp mills on the River Uruguay. As actors seeking to halt projects because of their potential harmful impact follow the choreography of EIA, the authoritative governance script is reinforced rather than undermined. There is a tragic aspect to this, in that those wishing to block a project are actually making it stronger. This points to a subtle de-politicization resulting from the evolution of instruments in use, and a need for their re-politicization

Public engagement with marine climate change issues: (Re)framings, understandings and responses

Climate change impacts on marine environments have been somewhat neglected in climate change research, particularly with regard to their social dimensions and implications. This paper contributes to addressing this gap through presenting a UK focused mixed-method study of how publics frame, understand and respond to marine climate change-related issues. It draws on data from a large national survey of UK publics (N = 1,001), undertaken in January 2011 as part of a wider European survey, in conjunction with in-depth qualitative insights from a citizens’ panel with participants from the East Anglia region, UK. This reveals that discrete marine climate change impacts, as often framed in technical or institutional terms, were not the most immediate or significant issues for most respondents. Study participants tended to view these climate impacts ‘in context’, in situated ways, and as entangled with other issues relating to marine environments and their everyday lives. Whilst making connections with scientific knowledge on the subject, public understandings of marine climate impacts were mainly shaped by personal experience, the visibility and proximity of impacts, sense of personal risk and moral or equity-based arguments. In terms of responses, study participants prioritised climate change mitigation measures over adaptation, even in high-risk areas. We consider the implications of these insights for research and practices of public engagement on marine climate impacts specifically, and climate change more generally

Opening up the participation laboratory: the co-creation of publics and futures in upstream participation.

How to embed reflexivity in public participation in techno-science and to open it up to the agency of publics are key concerns in current debates. There is a risk that engagements become limited to “laboratory experiments,” highly controlled and foreclosed by participation experts, particularly in upstream techno-sciences. In this paper, we propose a way to open up the “participation laboratory” by engaging localized, self-assembling publics in ways that respect and mobilize their ecologies of participation. Our innovative reflexive methodology introduced participatory methods to public engagement with upstream techno-science, with the public contributing to both the content and format of the project. Reflecting on the project, we draw attention to the largely overlooked issue of temporalities of participation, and the co-production of futures and publics in participation methodologies. We argue that many public participation methodologies are underpinned by the open futures model, which imagines the future as a space of unrestrained creativity. We contrast that model with the lived futures model typical of localized publics, which respects latency of materials and processes but imposes limits on creativity. We argue that to continue being societally relevant and scientifically important, public participation methods should reconcile the open future of research with the lived futures of localized publics

Bottom-up Infrastructures: Aligning Politics and Technology in building a Wireless Community Network

Contemporary innovation in infrastructures is increasingly characterized by a close relationship between experts and lay people. This phenomenon has attracted the attention from a wide range of disciplines, including computer-supported cooperative work (CSCW), science and technology studies (S&TS), organization studies and participatory design (PD). Connecting to this broad area of research, the article presents a qualitative case study concerning the building and maintenance of a grassroots, bottom-up information infrastructure in Italy, defined as wireless community network (WCN). Methodologically, the research is based on qualitative interviews with participants to the WCN, ethnographic observations and document analysis. The aim of the article is to understand the alignment between the technical work implied in building this bottom-up infrastructure and the political and cultural frameworks that move people to participate to this project. Relying on the field of science & technology studies, and in particular on the notions of ‘inverse infrastructure’ and ‘research in the wild’, we disclose the WCN’s peculiar innovation trajectory, localized outside conventional spaces of research and development. Overall, the presentation of the qualitative and ethnographic data allows to point out a more general reflection on bottom-up infrastructures and to enrich the academic debate concerning bottom-up infrastructuring work and other similar typologies of collaborative design projects in the domain of infrastructures

Deliberating stratospheric aerosols for climate geoengineering and the SPICE project

Increasing concerns about the narrowing window for averting dangerous climate change have prompted calls for research into geoengineering, alongside dialogue with the public regarding this as a possible response. We report results of the first public engagement study to explore the ethics and acceptability of stratospheric aerosol technology and a proposed field trial (the Stratospheric Particle Injection for Climate Engineering (SPICE) ‘pipe and balloon’ test bed) of components for an aerosol deployment mechanism. Although almost all of our participants were willing to allow the field trial to proceed, very few were comfortable with using stratospheric aerosols. This Perspective also discusses how these findings were used in a responsible innovation process for the SPICE project initiated by the UK’s research councils

Governance by campaign: the co-constitution of food issues, publics and expertise through new information and communication technologies

This paper considers food as a site of public engagement with science and technology. Specifically, we focus on how public engagement with food is envisioned and operationalised by one non-profit organisation, foodwatch. Founded in Germany in 2002, foodwatch extensively uses new information and communication technologies to inform consumers about problematic food industry practices. In this paper, we present our analysis of 50 foodwatch e-newsletters published over a period of one year (2013). We define foodwatch’s approach as ‘governance by campaign’ – an approach marked by simultaneously constituting: (a) key food governance issues, (b) affective publics that address these topics of governance through ICT-enabled media and (c) independent food and food-related expertise. We conclude our paper with a discussion of foodwatch’s mode of ‘governance by campaign’ and the democratic limits and potentials of a governance mode that is based on invited participation