Patient involvement and shared decision-making: an analysis of components, models and practical knowledge

Abstract

Patient involvement and shared decision-making are prominent ideas in healthcare policy discourses and the focus of extensive analysis in health services research and social sciences scholarship. In this paper, we reflect on the different kinds of knowledge that might help professionals to more fully translate these ideas and the broader ideals of collaborative healthcare, into everyday clinical practice. To do this, we offer a brief account of 8 components of involvement and indicate the ways in which the plurality of these components highlights the complexity of and dilemmas inherent in, patient involvement practices. We also present various models of involvement as ‘summary pictures’ which foreground specific constellations of these components. We argue that if we are to engage with involvement seriously, we require conceptions of knowledge that recognize and reflect the inherent tensions within and across models of involvement. That is, we need to pay attention not only to technical knowledge - the question of ‘what works’ - but also to ‘practical wisdom’ – the question of what counts as working from case to case.