Autonomy supportive decision-making in prenatal consultations: An interaction analysis.: Presenter(s): Joyce Kors, Amsterdam UMC, Faculty of Medicine, Vrije Universiteit Amsterdam, Research in Education, Netherlands

Autonomy supportive consultation (ASC) is a complex intervention, of which the outcome depends on interaction between patient and professional. ASC is based on Self-determination theory and theoretically well-described. Patients’ self-regulated behavior can be fostered by fulfillment of three basic psychological needs - autonomy, competence and relatedness. It is unknown to what extent professionals use mechanisms of ASC in prenatal decision-making. A detailed description of obstetric professionals’ interactions in practice could help to see what is needed to integrate ASC models and practice. To answer our research question ‘To what extent do obstetric professionals use mechanisms of ASC during prenatal decision-making?’ we conducted an interactional analysis of 20 audiotaped and transcribed prenatal consultations of 20 professionals. Analysis was based on concepts of Conversation Analysis (CA), using the five-step analytic tool of Pomerantz and Fehr. To ensure the reliability of results, we organized three data sessions, a standard practice for CA. We found three overarching themes: ‘Lightheartedness’ comprising the interactional mechanisms ‘minimizing language’ and ‘humor’. Interactions were quick and easy laced with humor and words like ‘little’ and ‘just’. The theme ‘Orientation to agreement’ describes how both professionals and patients seem to be oriented towards demonstrating agreement and mutual understanding, e.g. by frequently saying ‘Yes’. The resulting conversations show quick turn-taking, quick changes of the conversational content and no in-depth conversation. The last theme ‘Offering information and options’ describes the professional formally giving factual information almost completely without verbal interaction. The results of this study can firstly be used to refine the models of autonomy supportive consultation through adding minimizing language and humor to the mechanisms that can be used to fulfil the psychological need ‘relatedness’. Secondly, our results show that professionals use only few mechanisms described in literature to meet patients' psychological needs for 'competence' and 'autonomy'.