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How visual tools can help in shared decision-making


Pullin G, Cribb A. Picturing aesthetic futures: values and visual tools within shared decision-making. Integrated Healthcare Journal 2022;4:e000126

Why it matters

Shared decision-making helps to identify people’s values and tries to ensure decisions reflect what really matters to people, but this isn’t always easy. Consultation can be framed as professionals communicating advantages and disadvantages and providing evidence-based treatment information. It can be difficult to separate advantages from disadvantages and disabled people, for example, might feel at odds with the way that their disability can be framed in healthcare.

Shared decision-making tools or patient decision aids can play a role to empower patients to help them decide what’s important to them.


A visual tool was used as part of a public exhibition at the V&A Museum of Design, Dundee. The aim of the exhibition was to stimulate reflection and discussion about the potential roles both of disability in design and of design within healthcare. Around 140,000 museum visitors were invited to take part.

Participants had the option to identify as ‘a person with limb difference’, ‘a disabled person’ or ‘a healthcare professional’ and asked to choose from four photographs of different prosthetic hands:

  • a cosmetic life-like silicone glove
  • an overtly robotic looking hand
  • a hand worn inside a black rubber glove
  • a blank sheet representing not wearing a prosthesis (acknowledging this as a potential positive choice).

Another set of photographs involved abstract visual details of non-medical objects like clothing that might relate to perceptions of a personal object. Participants could add these to their choice of prosthetic and were invited to give their reasons.

What we found

Over 7000 visitors completed the exercise.  The responses showed people’s preferences, and highlighted dilemmas and values that lay behind their choices. There were several responses about managing identity as a disabled person. One respondent said, “I feel a tension between wanting to make it look as ‘normal hand’ as possible vs. embracing technology and opportunity. It doesn’t try to hide or mask what has happened. It shows that I have accepted this and moved on.”

The intersection of disability and aesthetics introduces complexities that are virtually impossible to discuss through text and numbers alone. Our study argues that carefully designed and creatively engaging visual tools can play a crucial role and suggest that these insights have broader relevance for extending and strengthening shared decision-making practices.

There is scope for adopting and adapting a broad prototyping approach for many kinds of healthcare decisions including encouraging and helping people to imagine future lives with or without various treatments, objects, adaptations to environments.

Although arts-based practices are not uncommon in healthcare, they are usually complementary activities separate from core clinical practice. The study stresses that design practices could sometimes form part of a core interaction between clinicians and patients, helping to subtly reframe and deepen relationships. The study also envisages a network that brings together healthcare professionals, service providers, disabled people, designers and bioethicists, supporting a joined-up yet value-based approach.

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