Collaborative Decision Making: Shared Mind

Patients frequently come to health care settings accompanied by trusted family members or friends, not only for psychological support but also to help them organize and recall information and think through important decisions. Typically, these social influences have been considered as either promoting or restricting an individual's own perceptions, cognitive processing, and emotions. Research now suggests that mental processes as diverse as perception, problem recognition, problem solving, and deciding about important issues may not be the result of cognitive processes solely within the mind of one individual. Rather, these processes are shared in some way across the cognitive and affective schemas of two or more individuals—sometimes to the point that no single individual can fully “own” the resulting perspective, preference, or choice.

These shared interpersonal processes, variously described as distributed, collaborative, collective, situated, interactive, and extended cognition, are subsumed by the concept of “shared mind,” defined as “situations in which new ideas and perspectives emerge through the sharing of thoughts, feelings, perceptions, meanings, and intentions among two or more people.” Shared mind may occur on cognitive, affective, motor, and organizational levels, each of which has implications for communication in health care settings.

The concept of shared mind draws on a rich body of experimental work. Social psychological research on decision making in young children and older people with cognitive impairments has demonstrated ways in which individuals bolster each other's cognitive functioning. Neurocognitive research using functional imaging in paired subjects (e.g., married couples, physician-patient dyads) suggests that there are naturally occurring resonance pathways across individuals. Research on primates has elaborated how mirror neurons can reveal shared mental processing. It appears that shared mental processing is ubiquitous.

Shared mind may be tacit and naturally occurring; for example, a married couple might share a common perspective. Shared mind can also be the result of an intentional, planned process such as during a family meeting to discuss end-of-life care for a critically ill patient. In this situation, two or more people explicitly recognize the need to discuss values, goals, perspectives, and preferences. Shared mind can be made more explicit by using metacommunicative comments such as, “Let's think through this together,” and asking [Page 200]patients directly about relevant influences on the decision-making process (“With whom have you discussed this? Did they help you to clarify things?”).

Shared mind also includes emotions and feelings. Attunement, resonance, and “being on the same wavelength” may be naturally occurring, but in clinical settings often need to be explicit and intentional. Promoting attunement requires crafting linguistic and paralinguistic communication to convey connection, trust, and empathy. Shared mind may be expressed physically, through mirroring of facial expressions, body posture, vocal inflection, and gestures. Emotions and feelings are central to decision-making processes, and thus studying affective resonance and attunement also offers rich possibilities in clinical decision-making research.

Shared mind is characterized by “cohesion”—sufficient overlap in participants' mental models of a situation to permit a shared perspective and collaborative decision making. Shared mind can apply not only to dyads, but also to groups such as health care teams and families. When well-functioning, groups promote effective problem recognition, cohesion, and efficiency of communication. Often, though, groups are not naturally cohesive and need to develop such cohesion intentionally. Clinical communication should thus not only make sure that all opinions and views are voiced and heard; new ideas and perspectives should emerge from within group interactions [Page 201]that would not have necessarily resulted from the independent contemplation of the situation by any one individual. This phenomenon is familiar to lovers of jazz—improvisations reflect the shared musical language among the players (including its structural, affective, motor, and organizational qualities) as much as the individual creativity of any one of them.

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