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This article reports on a study of such patients and their clinicians engaged in shared decision-making. Shared decision-making is a collaborative approach that seeks to value and centre patients\u2019 preferences, potentially addressing asymmetries of knowledge and power between clinicians and patients by countering medical authority with greater patient empowerment. We studied shared decision-making practices in the context of major surgery by recruiting 16 patients contemplating either colorectal, cardiac or joint replacement surgery in the UK National Health Service (NHS). Over 18\u2009months 2019\u20132020, we observed and video-recorded decision-making consultations, studied the organisational and clinical context for consultations, and interviewed patients and clinicians about their experiences of making decisions. Linguistic ethnography, the study of communication and interaction in context, guided us to analyse the interplay between interactions (during consultations between clinicians, patients and family members) and clinical and organisational features of the contexts for those interactions. We found that the framing of consultations as being about life-saving or life-enhancing procedures was important in producing three different genres of consultations focused variously on: resolving problems, deliberation of options and evaluation of benefits of surgery. We conclude that medical authority persists, but can be used to create more deliberative opportunities for decision-making through amending the context for consultations in addition to adopting appropriate communication practices during surgical consultations.<\/jats:p>","DOI":"10.1177\/13634593241238857","type":"journal-article","created":{"date-parts":[[2024,3,22]],"date-time":"2024-03-22T01:13:55Z","timestamp":1711070035000},"page":"200-219","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Clinical context and communication in shared decision-making about major surgery: Findings from a qualitative study with colorectal, orthopaedic and cardiac patients"],"prefix":"10.1177","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2930-1125","authenticated-orcid":false,"given":"Gemma","family":"Hughes","sequence":"first","affiliation":[{"name":"University of Leicester, UK"},{"name":"University of Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy J","family":"Stephens","sequence":"additional","affiliation":[{"name":"Queen Mary University of London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas M","family":"Seuren","sequence":"additional","affiliation":[{"name":"University of Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rupert M","family":"Pearse","sequence":"additional","affiliation":[{"name":"Queen Mary University of London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara E","family":"Shaw","sequence":"additional","affiliation":[{"name":"University of Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,3,21]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aex137"},{"key":"e_1_3_3_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.0141-9889.2004.00426.x"},{"key":"e_1_3_3_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-9566.2005.00469.x"},{"key":"e_1_3_3_5_1","volume-title":"Medical Talk and Medical Work: The Liturgy of the Clinic","author":"Atkinson P","year":"1995","unstructured":"Atkinson P (1995) Medical Talk and Medical Work: The Liturgy of the Clinic. 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