Rethinking decision-making in the context of preventive medication: how taking statins becomes "the right thing to do"

Louisa Polak; Judith Green

doi:10.1016/j.socscimed.2020.112797

Rethinking decision-making in the context of preventive medication: how taking statins becomes "the right thing to do"

Louisa Polak, Judith Green

Population Health Sciences

Research output: Contribution to journal › Article › peer-review

8 Citations (Scopus)

196 Downloads (Pure)

Abstract

To understand decision-making in the context of longterm preventive medication, we explore the way “deciding” articulates with household medication practices and other everyday routines. Taking statins as a case study, we use qualitative data from interviews with 34 participants in the UK who had all been offered statins; 19 were currently taking them. Although all participants reference similar information about statins, the way they assemble and use their knowledge varies: there is a marked asymmetry between participants taking statins and those not taking them. Deliberation is a prominent feature of accounts of deciding not to take statins, but seldom visible within accounts of those taking them. Statin-takers emphasise that they have “no choice” about taking them, while non-takers stress the need to “think about it”; statin-takers’ accounts prioritise biomedical tests over experiential knowledge, whereas non-takers sometimes prioritise experiential knowledge. All participants reference similar theoretical and experiential knowledge about side-effects, but whereas non-takers often use this knowledge to explain their decision to decline statins, those taking statins downplay both their own experiences and the likelihood that these are due to statins. To account for these asymmetries, we propose a model of decision-making in which deciding upon a course of action entails constructing a narrative presentation of medication use that frames it as “the right thing to do”. This model helps us examine the two-way interactions between decision-making and the material practices through which regular medication gets taken, interactions often elided from accounts both of decision-making and of medication practice. In the context of longterm medication, the boundaries between “deciding” and “doing” are blurred; decision-making is situated within a web of collaborative, discursively-informed practices.

Original language	English
Article number	112797
Journal	Social Science & Medicine
Volume	247
Early online date	10 Jan 2020
DOIs	https://doi.org/10.1016/j.socscimed.2020.112797
Publication status	Published - 1 Feb 2020

Keywords

Decision-making
Knowledge construction
Medication practices
Qualitative
Statins
UK

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10.1016/j.socscimed.2020.112797

Rethinking decision-making in_POLAK_Accepted9January2020Publishedonline10January2020_GREEN AAM (CC BY-NC-ND)Accepted author manuscript, 353 KBLicence: CC BY-NC-ND

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abstract = "To understand decision-making in the context of longterm preventive medication, we explore the way “deciding” articulates with household medication practices and other everyday routines. Taking statins as a case study, we use qualitative data from interviews with 34 participants in the UK who had all been offered statins; 19 were currently taking them. Although all participants reference similar information about statins, the way they assemble and use their knowledge varies: there is a marked asymmetry between participants taking statins and those not taking them. Deliberation is a prominent feature of accounts of deciding not to take statins, but seldom visible within accounts of those taking them. Statin-takers emphasise that they have “no choice” about taking them, while non-takers stress the need to “think about it”; statin-takers{\textquoteright} accounts prioritise biomedical tests over experiential knowledge, whereas non-takers sometimes prioritise experiential knowledge. All participants reference similar theoretical and experiential knowledge about side-effects, but whereas non-takers often use this knowledge to explain their decision to decline statins, those taking statins downplay both their own experiences and the likelihood that these are due to statins. To account for these asymmetries, we propose a model of decision-making in which deciding upon a course of action entails constructing a narrative presentation of medication use that frames it as “the right thing to do”. This model helps us examine the two-way interactions between decision-making and the material practices through which regular medication gets taken, interactions often elided from accounts both of decision-making and of medication practice. In the context of longterm medication, the boundaries between “deciding” and “doing” are blurred; decision-making is situated within a web of collaborative, discursively-informed practices. ",

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Rethinking decision-making in the context of preventive medication: how taking statins becomes "the right thing to do"

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Keywords

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