How option-listing influences decision-making in orthopedic consultations: a conversation analytic study.

Abstract

Examine which practices orthopedists use to do option-listing, a technique that can facilitate shared decision-making (SDM). A conversation analytic study of 35 orthopedic consultations with newly referred patients with hip and/or knee osteoarthritis. Orthopedists implement option-listing in consultations using two organizational principles: 1) A fixed order of options that constitutes a scale (based on the severity of treatment). Presenting this scale (in two possible orders) encodes this fixed order; 2) Options are presented in relation to each other, rather than as individual options to be discussed incrementally. This format provides orthopedists with interactional slots to formulate their professional stance by presenting options as considered but rejected. Patients co-construct this list by taking a recipient role and not responding to the individual items of the list. Option-listing can facilitate SDM, allowing patients to choose amongst options. A drawback is that, while the organizational principles of option-listing allow orthopedists to express a professional opinion, they also place patients in an interactional position in which they have to address the orthopedists' epistemic stance. On the other hand, patients can use the scale to propose their own preferences. Awareness of the interactional consequences of option-listing might optimize SDM.