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Abstract
Introduction People living with multiple chronic conditions experience illness and activities of care as woven into everyday life. Mobility limitations, chronic fatigue, dialysis, depression, compromised immunity and other medical issues color how life feels, and shape its routines, challenges, relationships, work, sources of joy, threats, possibilities, and meaning. Medical problems become everyday problems, and life problems meld into medical ones. Here, SDM as co-production focusses less on which treatment, and more on how to change the patient’s life situation for the better and enable a situation in which treatment is feasible, sustainable, desirable, and life enhancing. SDM observer measures don’t tell us if this is happening. We sought a theoretical framework for a measure that would.
Methods Pragmatist philosopher, John Dewey, articulates a structure for practically changing problematic situations. Recognizing its practicality, scholars and practitioners from medicine, ethics, nursing, public policy, and design have adapted Dewey’s work. We followed a similar approach.
Results We identified the following Dewey-esque question as that which an observer measure should answer ‘in this encounter, were the patient and clinician working together to produce a response to a problematic situation?’ (co-productive SDM). Dewey’s theory of inquiry identifies functional acts performed to resolve problematic situations. We modified his terminology to suit. See figure 1.
Conclusion Focusing SDM measurement on detecting the acts that people collaboratively perform to practically change problematic situations is a novel approach suited to the realities of living with and caring for multiple chronic conditions.
