Broadening perspectives on sharing decisions about medical treatment – the case of shoulder disease

Background<br/>Healthcare is increasingly criticized for pursuing goals and outcomes that do not prioritize patients’ best interests. Involving patients in decision-making through approaches like shared decision-making (SDM) is being promoted as an effective way to enhance healthcare and make it more patient-centered and value-based. However, implementing decision-making models has proven challenging, as they rely on idealized notions of rational deliberation and autonomy. To tackle urgent quality issues in healthcare, we must adopt more nuanced methods for potentially sharing decisions about medical treatment.<br/>Purpose<br/>This study aimed to investigate everyday decision-making about surgical treatment in the orthopedic shoulder clinic.<br/>Method<br/>The study is based on qualitative, ethnographic methods of participant observation in two public orthopedic shoulder clinics (six months) and interviews with eight patients. Analysis of the material<br/>follows an abductive approach to oscillate between the data and anthropological and sociological theories on decision-making.<br/>Results<br/>The study reveals that in routine clinical decision-making, choices regarding surgery emerge from the expectations of both the patient and clinician prior to their meeting, the inherent uncertainty of the circumstance, and the pursuit of enhancing quality of life instead of merely prolonging it. These themes do not manifest through neutral terminologies, technologies, or theoretical concepts; instead, they reflect a continuous evaluation of both short-term and long-term investments in the body, tailored to the unique context of each situation.<br/>Conclusions<br/>Attention to decision-making nuances in medical specialties could effectively enhance treatment pathways and improve patient communication.