Lian, OS 
ORCID: 0000-0002-5752-1486, Nettleton, S, Grange, H and Dowrick, C ORCID: 0000-0002-4245-2203
(2023)
‘I’d best take out life insurance, then.’ Conceptualisations of risk and uncertainty in primary care consultations, and implications for shared decision-making
Health Risk and Society, 25 (5-6).
pp. 234-251.
ISSN 1369-8575, 1469-8331
Abstract
The main objective of this study is to gain knowledge about interactional factors that support and obstruct mutual risk-assessments and shared decision-making (SDM) in clinical consultations. Through a narrative analysis of verbatim transcripts of 28 naturally occurring consultations performed in English National Health Service practices, we explore the ways in which patients and general practitioners conceptualise, construct and negotiate risks related to diagnostic tests and medical treatments. Consultations were sampled from a corpus of 212 consultation transcripts from the One in a Million: Primary care consultations archive on the basis that they contained the word ‘risk(s)’. Most sampled cases relate to cardiovascular conditions and cancer. Drawing on a social constructionist perspective and the relational theory of risk, we found that while GPs talked about mathematical-probabilistic population risk, patients expressed their own experiences of possible future dangers, conceptualised through words like ‘worried’, ‘scared’ and ‘concerned’. Risk objects, defined here as entities to which harmful consequences are conceptually attached, were constructed differently by patients and GPs, especially in relation to cardiovascular risks. Their different rationalities sometimes obstructed any form of mutual risk-assessments. The relational theory of risk proved to be a useful theoretical frame for exploring layers and configurations of risk constructions among patients and clinicians, and for capturing interactional factors that support and obstruct mutual risk-assessments and SDM. For patients to be able to engage in genuine dialogues and make informed decisions about their care, it is paramount for patients and doctors to co-construct patients’ health-risks during clinical encounters.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | 4203 Health Services and Systems, 42 Health Sciences, Health Services, Prevention, Clinical Research, 7.3 Management and decision making, Cardiovascular, 3 Good Health and Well Being |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 06 Aug 2024 13:27 |
| Last Modified: | 24 Jan 2026 04:11 |
| DOI: | 10.1080/13698575.2023.2197780 |
| Open Access URL: | https://doi.org/10.1080/13698575.2023.2197780 |
| Related Websites: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3183371 |
| Disclaimer: | The University of Liverpool is not responsible for content contained on other websites from links within repository metadata. Please contact us if you notice anything that appears incorrect or inappropriate. |
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