--- title: "Pts' fear be labeled difficult-obstacle to shared dec making | Sutter Health" description: "MDs may not be aware of a need to create a safe env. for open communication to facilitate shared decision making. Rigorous measures of pt engagemt are needed." url: "https://www.sutterhealth.org/research/publications/pts-fear-label-difficult-obstacle-shared-decmaking-1055312526" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Pts' fear be labeled difficult-obstacle to shared dec making # Authoritarian physicians and patients' fear of being labeled 'difficult' among key obstacles to shared decision making. Frosch DL, May SG, Rendle KA, Tietbohl C, & Elwyn G. _Health Aff (Millwood). 31(5):1030-8. doi: 10.1377/hlthaff.2011.0576._ 2012-05-01 ## Abstract Relatively little is known about why some patients are reluctant to engage in a collaborative discussion with physicians about their choices in health care. To explore this issue further, we conducted six focus-group sessions with forty-eight people in the San Francisco Bay Area. In the focus groups, we found that participants voiced a strong desire to engage in shared decision making about treatment options with their physicians. However, several obstacles inhibit those discussions. These include the fact that even relatively affluent and well-educated patients feel compelled to conform to socially sanctioned roles and defer to physicians during clinical consultations; that physicians can be authoritarian; and that the fear of being categorized as "difficult" prevents patients from participating more fully in their own health care. We argue that physicians may not be aware of a need to create a safe environment for open communication to facilitate shared decision making. Rigorous measures of patient engagement, and of the degree to which health care decisions truly reflect patient preferences, are needed to advance shared decision making in clinical practice. [PubMed abstract](http://www.ncbi.nlm.nih.gov/pubmed/22566443) ## Research topics - [Disease Management](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Disease+Management%5C%22%22) - [Health Services](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Health+Services%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Implementing shared decision-making: consider all the consequences.](https://www.sutterhealth.org/research/publications/shared-decision-making-allconsequences-1055312516) Elwyn G, Frosch DL, Kobrin S. Implement Sci. 11:114. doi: 10.1186/s13012-016-0480-9. 2016 Aug 08 - Publication ### [Collaborative deliberation: a model for patient care.](https://www.sutterhealth.org/research/publications/collaborative-deliberation-pt-care-model-1055312489) Elwyn G, Lloyd A, May C, van der Weijden T, Stiggelbout A, Edwards A, Frosch DL, Rapley T, Barr P, Walsh T, Grande SW, Montori V, Epstein R. Patient Educ Couns. 97(2):158-64. doi: 10.1016/j.pec.2014.07.027. Epub 2014 Aug 13. 2014 Nov 01 - Publication ### ["Many miles to go …": a systematic review of the implementation of patient decision support interventions into routine clinical practice.](https://www.sutterhealth.org/research/publications/review-implementation-pt-dec-spt-interventions-1055312535) Elwyn G, Scholl I, Tietbohl C, Mann M, Edwards AG, Clay C, Légaré F, van der Weijden T, Lewis CL, Wexler RM, Frosch DL. BMC Med Inform Decis Mak. 13(suppl 2):S14. doi: 10.1186/1472-6947-13-S2-S14. Epub 2013 Nov 29. 2013 Jan 01 - Publication ### [Decision or no decision: how do patient-physician interactions end and what matters?](https://www.sutterhealth.org/research/publications/pt-md-endings-decision-or-no-1055312572) Tai-Seale M, Bramson R, Bao X. J Gen Intern Med. 22(3):297-302. 2007 Mar 01 - Publication ### [Implementation of patient decision support interventions in primary care: the role of relational coordination.](https://www.sutterhealth.org/research/publications/pt-decision-spt-primary-care-relational-coord-1055312888) Tietbohl CK, Rendle KA, Halley MC, May SG, Lin GA, Frosch DL. Med Decis Making. 35(8):987-98. doi: 10.1177/0272989X15602886. Epub 2015 Aug 27. 2015 Nov 01 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/pts-fear-label-difficult-obstacle-shared-decmaking-1055312526#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Pts' fear be labeled difficult-obstacle to shared dec making"}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/pts-fear-label-difficult-obstacle-shared-decmaking-1055312526#medicalscholarlyarticle","name":"Authoritarian physicians and patients' fear of being labeled 'difficult' among key obstacles to shared decision making.","headline":"Pts' fear be labeled difficult-obstacle to shared dec making","abstract":"Relatively little is known about why some patients are reluctant to engage in a collaborative discussion with physicians about their choices in health care. 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Rigorous measures of patient engagement, and of the degree to which health care decisions truly reflect patient preferences, are needed to advance shared decision making in clinical practice.","description":"MDs may not be aware of a need to create a safe env. for open communication to facilitate shared decision making. 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