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Understanding and Characterizing Shared Decision-Making and Behavioral Intent in Medical Uncertainty

Author: Roxana M. Maffei, RN, MSN (2011)

Primary Advisor: Kim Dunn, MD, PhD

Committe Members: Jiajie Zhang, PhD; Chiehwen E. Hsu, PhD, MPH; John H. Holmes, PhD

PhD Thesis, The University of Texas School of Biomedical Informatics at Houston.


There is always some degree of medical uncertainty present when it comes to medical reasoning. Shared decision-making (SDM) has been identified as an effective technique for managing uncertainty involving two or more parties. Despite the identification of SDM as an effective technique, it is under circumstances of medical uncertainty, where even less shared decision-making is practiced between a physician and patient.   How do we move away from this cycle of negative relationship between shared decision-making and medically uncertain situations?  The communication and relation between patient and physician seen when SDM is practiced, calls for the need to understand and incorporate human behavioral elements in order to successfully achieve the benefits that SDM has to offer. To address this gap in knowledge of how to fully implement SDM in medical care when uncertainty is present, a theoretical framework has been constructed based on a behavioral informatics approach. The belief is that this framework will allow one to 1)   better understand key elements involved in shared decision-making when a medical uncertainty is involved; 2) identify characteristics of human behavioral intent and determine its influence in patient/physician shared decision-making process; and 3)  measure a patient’s preference for information and active involvement in healthcare.