ArticleHealth expectations : an international journal of public participation in health care and health policy1999
Is 'shared decision-making' feasible in consultations for upper respiratory tract infections? Assessing the influence of antibiotic expectations using discourse analysis.
Article in Health expectations : an international journal of public participation in health care and health policy, 1999. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
29 citing papers in PubMed, 6 syntheses or guidelines pooled it, 67 citations in OpenAlex.
- Barriers and facilitators of pediatric shared decision-making: a systematic review.Implementation science : IS · 2019Pooled it
- Antibiotic prescribing for acute respiratory tract infections in primary care: an updated and expanded meta-ethnography.The British journal of general practice : the journal of the Royal College of General Practitioners · 2018Pooled it
- A systematic review of parent and clinician views and perceptions that influence prescribing decisions in relation to acute childhood infections in primary care.Scandinavian journal of primary health care · 2015Pooled it
- How communication affects prescription decisions in consultations for acute illness in children: a systematic review and meta-ethnography.BMC family practice · 2014Pooled it
- A systematic review of the research on communication between patients and health care professionals about medicines: the consequences for concordance.Health expectations : an international journal of public participation in health care and health policy · 2004Pooled it
- Shared decision making: developing the OPTION scale for measuring patient involvement.Quality & safety in health care · 2003Pooled it
- One size does not fit all: evaluating an intervention to reduce antibiotic prescribing for acute bronchitis.BMC health services research · 2013Trial
- A randomised controlled trial of delayed antibiotic prescribing as a strategy for managing uncomplicated respiratory tract infection in primary care.The British journal of general practice : the journal of the Royal College of General Practitioners · 2001Trial
- Saving Shared Decision-Making.Journal of general internal medicine · 2025Article
- Antimicrobial Prescription Behavior in Equine Asthma Cases: An International Survey.Animals : an open access journal from MDPI · 2024Article
- Article
- A Qualitative Description of Clinician Free-Text Rationales Entered within Accountable Justification Interventions.Applied clinical informatics · 2022Article
- Choosing between medical management and liver transplant in urea cycle disorders: A conceptual framework for parental treatment decision-making in rare disease.Journal of inherited metabolic disease · 2020Article
- Conflict Between Direct Experience and Research-Based Evidence Is a Key Challenge to Evidence-Based Respiratory Medicine on British Racing Yards.Frontiers in veterinary science · 2020Article
- General practitioners' accounts of negotiating antibiotic prescribing decisions with patients: a qualitative study on what influences antibiotic prescribing in low, medium and high prescribing practices.BMC family practice · 2019Article
- "What would you recommend doctor?"-Discourse analysis of a moment of dissonance when sharing decisions in clinical consultations.Health expectations : an international journal of public participation in health care and health policy · 2019Article
- How does decision complexity affect shared decision making? An analysis of patient-provider antiretroviral initiation dialogue.Patient education and counseling · 2017Article
- Influence of Clinical Communication on Parents' Antibiotic Expectations for Children With Respiratory Tract Infections.Annals of family medicine · 2016Article
- Mutual influence in shared decision making: a collaborative study of patients and physicians.Health expectations : an international journal of public participation in health care and health policy · 2009Article
- 'Breaking up is hard to do': perspectives of general practitioners and patients towards removals from GP lists.Irish journal of medical science · 2007Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo examine the discourse of consultations in which conflict occurs between parents and clinicians about the necessity of antibiotics to treat an upper respiratory tract infection. To appraise the feasibility of shared decision-making in such consultations.
designA qualitative study using discourse analysis techniques.
settingA general practice with 12 500 patients in an urban area of Cardiff, Wales.
participantsTwo consultations were purposively selected from a number of audiotaped sessions. The consultations took place during normal clinics in which appointments are booked at 7-minute intervals. The practitioner is known to be interested in involving patients in treatment decisions.
methodDiscourse analysis was employed to examine the consultation transcripts. This analysis was then compared with the theoretical competencies proposed for 'shared decision-making'.
resultsThe consultations exhibit less rational strategies than those suggested by the shared decision-making model. Strong parental views are expressed (overtly and covertly) which seem derived from prior experiences of similar illnesses and prescribing behaviours. The clinician responds by emphasizing the 'normality' of upper respiratory tract infections and their recurrence, accompanied by expressions that antibiotic treatment is ineffective in 'viral' illness - the suggested diagnosis. The competencies of 'shared decision-making' are not exhibited.
conclusionsThe current understanding of shared decision-making needs to be developed for those situations where there are dis-agreements due to the strongly held views of the participants. Clinicians have limited strategies in situations where patient treatment preferences are opposed to professional views. Dispelling 'misconceptions' by sharing information and negotiating agreed management plans are recommended. But it seems that communication skills, information content and consultation length have to receive attention if such strategies are to be employed successfully.
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.