Strategic Maneuvering in Treatment Decision-Making Discussions: Two Cases in Point

Over the past decade, the ideal model of shared decision-making has been increasingly promoted as the preferred standard of doctor-patient communication in medical consultation. The model advocates a treatment decision-making process in which the doctor and his patient are considered coequal partners that carefully negotiate the treatment options available in order to ultimately reach a treatment decision that is mutually shared. Thereby, the model notably leaves room for—and stimulates—argumentative discussions to arise in the context of medical consultation. A paradigm example of a discussion that often emerges between doctors and their patients concerns antibiotics as a method of treatment for what is presumed to be a viral infection. Whereas the doctor will generally not encourage treatment with antibiotics, patients oftentimes prefer the medicine to other methods of treatment. In this paper, two cases of such antibiotic-related discussions in consultation are studied using insights gained in the extended pragma-dialectical theory to argumentation. It is examined how patient and physician maneuver strategically in order to maintain a balance between dialectical reasonableness and rhetorical effectiveness, as well as an equilibrium between patient participation and evidence-based medication, while arguing a case for and against antibiotics respectivel

Conflict and consultation: Strategic manoeuvring in response to an antibiotic request

In recent years, the model of shared decision-making has become increasingly promoted as the preferred standard in doctor-patient communication. As the model considers doctor and patient as coe-qual partners that negotiate their preferred treatment options in order to reach a shared decision, shared de-cision-making notably leaves room for the usage of argumentation in the context of medical consultation. A paradigm example of argumentative conflict in consultation is the discussion that emerges between doctors and their patients concerning antibiotics as a method of treatment for what is presumed to be a viral infec-tion. In this paper, a case of such argumentative conflict is studied, using the extended pragma-dialectical theory to argumentation. It is examined how a patient and her physician manoeuvre strategically in order to maintain a balance between dialectical reasonableness and rhetorical effectiveness, as well as an equilibri-um between patient participation and evidence-based medication, while arguing their case for and against antibiotics respectively

Eliciting preferences of persons with dementia and informal caregivers to support ageing in place in the Netherlands:a protocol for a discrete choice experiment

Introduction:Ageing in place (AIP) for persons with dementia is encouraged by European governments and societies. Healthcare packages may need reassessment to account for the preferences of care funders, patients and informal caregivers. By providing insight into people's preferences, discrete choice experiments (DCEs) can help develop consensus between stakeholders. This protocol paper outlines the development of a Dutch national study to cocreate a healthcare package design methodology built on DCEs that is person-centred and helps support informal caregivers and persons with dementia to AIP. A subpopulation analysis of persons with dementia with a migration background is planned due to their high risk for dementia and under-representation in research and care. Methods and analysis:The DCE is designed to understand how persons with dementia and informal caregivers choose between different healthcare packages. Qualitative methods are used to identify and prioritise important care components for persons with dementia to AIP. This will provide a list of care components that will be included in the DCE, to quantify the care needs and preferences of persons with dementia and informal caregivers. The DCE will identify individual and joint preferences to AIP. The relative importance of each attribute will be calculated. The DCE data will be analysed with the use of a random parameters logit model. Ethics and dissemination:Ethics approval was waived by the Amsterdam University Medical Center (W23_112 #23.137). A study summary will be available on the websites of Alzheimer Nederland, Pharos and Amsterdam Public Health institute. Results are expected to be presented at (inter)national conferences, peer-reviewed papers will be submitted, and a dissemination meeting will be held to bring stakeholders together. The study results will help improve healthcare package design for all stakeholders.</p

Strategic Maneuvering in Treatment Decision-Making Discussions:Two Cases in Point

Over the past decade, the ideal model of shared decision-making has been increasingly promoted as the preferred standard of doctor-patient communication in medical consultation. The model advocates a treatment decision-making process in which the doctor and his patient are considered coequal partners that carefully negotiate the treatment options available in order to ultimately reach a treatment decision that is mutually shared. Thereby, the model notably leaves room for-and stimulates-argumentative discussions to arise in the context of medical consultation. A paradigm example of a discussion that often emerges between doctors and their patients concerns antibiotics as a method of treatment for what is presumed to be a viral infection. Whereas the doctor will generally not encourage treatment with antibiotics, patients oftentimes prefer the medicine to other methods of treatment. In this paper, two cases of such antibiotic-related discussions in consultation are studied using insights gained in the extended pragma-dialectical theory to argumentation. It is examined how patient and physician maneuver strategically in order to maintain a balance between dialectical reasonableness and rhetorical effectiveness, as well as an equilibrium between patient participation and evidence-based medication, while arguing a case for and against antibiotics respectively

Ik heb nu de blik van de patiënt

Gezondheidscommunicatie-expert ondervindt het belang van haar vak aan den lijve

[Recensie:] Medische mensentaal: een aanrader voor beginnende beroepsbeoefenaars in de zorg

Boekbespreking van Frans Meijman & Annelies Bakker, Medische mensentaal: Taal en communicatie over gezondheid, ziekte en zorg, De Tijdstroom, Utrecht, 2018, ISBN 978 90 5898 322 0, 314 pp. Prijs: € 42,50

“Doctor, I disagree”: Development and preliminary validation of a patient argumentativeness scale

In medical consultations, disagreements may arise. Yet, patients' predisposition to engage in a discussion with their doctors to resolve these disagreements may vary. This study aims to develop and validate a measurement tool to assess patient argumentativeness (P-ARG) in general practice. Starting from the pragma-dialectical theory of argumentation and Infante and Rancer's (1982) argumentativeness scale, scale items were developed and subsequently administered to 183 participants. Principal component analysis was conducted to explore the scale structure. Also, convergent and concurrent validity were assessed. The results confirmed a two-factor scale structure and provided preliminary support for its validity. While further refinement is required, the (preliminary) P-ARG scale can be used for research purposes by medical argumentation as well as health communication scholars, e.g., to explore the relationships between doctors' provision of argumentation, patients' perspectives thereof, and patient argumentativeness