Navigating Between Involving and Advising Clients: An Analysis of Dietitians’ Advisory Practices Within Shared Decision-Making Processes

Based on a Dutch corpus of 40 dietitian-client conversations on malnutrition in the primary care setting, we use conversation analysis to investigate how dietary advice is provided in the context of shared decision-making. We demonstrate how client involvement is encouraged in some ways but constrained in others, making it difficult for clients to accept advice and making it less responsive to their concerns. First, we show how dietitians invite clients to co-create the basis of the advice. However, once clients participate in establishing the underlying logic of the advice, it becomes difficult for them to raise objections or propose alternative solutions. Later pursuits of commitment by dietitians lead clients to mainly align with the practitioner's line of reasoning, rather than to engage in practices of shared decision-making. Our study highlights the importance of timing in engaging clients during dietary counseling. By making dietitians more aware of interactional practices and their consequences, client engagement can be improved, further increasing the effectiveness of dietary intervention to treat (risk of) malnutrition.