‘My cousin said to me..’ Patients’ use of third-party references to facilitate shared decision-making during naturally occurring primary care consultations

Lian, OS ORCID: 0000-0002-5752-1486, Nettleton, S, Grange, H ORCID: 0000-0002-3791-1321 and Dowrick, C ORCID: 0000-0002-4245-2203 (2024) ‘My cousin said to me..’ Patients’ use of third-party references to facilitate shared decision-making during naturally occurring primary care consultations Health United Kingdom, 28 (5). pp. 775-794. ISSN 1363-4593, 1461-7196

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Abstract

In this paper, we explore the ways in which patients invoke third parties to gain decision-making influence in clinical consultations. The patients’ role in decision-making processes is often overlooked, and this interactional practice has rarely been systematically studied. Through a contextual narrative exploration of 42 naturally occurring consultations between patients (aged 22–84) and general practitioners (GPs) in England, we seek to fill this gap. By exploring how and why patients invoke third parties during discussions about medical treatments, who they refer to, what kind of knowledge their referents possess, and how GPs respond, our main aim is to capture the functions and implications of this interactional practice in relation to decision-making processes. Patients refer to third parties during decision-making processes in most of the consultations, usually to argue for and against certain treatment options, and the GPs recognise these utterances as pro-and-contra arguments. This enables patients to counter the GPs’ professional knowledge through various knowledge-sources and encourage the GPs to target their specific concerns. By attributing arguments to third parties, patients claim decision-making influence without threatening the GPs’ authority and expertise, which their disadvantaged epistemic position demands. Thereby, patients become able to negotiate their role and their epistemic position, to influence the agenda-setting, and to take part in the decision-making process, without being directly confrontational. Invoking third parties is a non-confrontational way of proposing and opposing treatment options that might facilitate successful patient participation in decision-making processes, and so limit the risk of patients being wronged in their capacity as knowers.

Item Type:	Article
Uncontrolled Keywords:	Humans, Communication, Physician-Patient Relations, Adult, Aged, Aged, 80 and over, Middle Aged, Patient Participation, Referral and Consultation, Primary Health Care, England, Female, Male, General Practitioners, Decision Making, Shared
Depositing User:	Symplectic Admin
Date Deposited:	07 Aug 2024 13:52
Last Modified:	24 Jan 2026 04:31
DOI:	10.1177/13634593231188489
Open Access URL:	https://doi.org/10.1177/13634593231188489
Related Websites:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3183424
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