Shared decision making models to inform an interprofessional perspective on decision making: A theory analysis

doi:10.1016/j.pec.2009.10.015

Patient Education and Counseling

Volume 80, Issue 2, August 2010, Pages 164-172

https://doi.org/10.1016/j.pec.2009.10.015 Get rights and content

Abstract

Objective

To conduct a theory analysis of shared decision making (SDM) conceptual models and determine the extent to which the models are relevant to interprofessional collaboration in clinical practice.

Methods

Theory analysis of SDM models identified from three systematic reviews and personal files. Eligible publications: model of SDM; described concepts with relational statements. Two independently appraised models.

Results

Of 54 publications, 15 unique models included 18 core concepts. Of two models that included more than one health professional collaborating with the patient, one included 3 of 10 elements of interprofessional collaboration and the other included 1 element. Fourteen were rated as having no logical fallacies, 10 as parsimonious, 7 had been empirically tested, 4 provided testable hypotheses, and 3 described the development process.

Conclusion

Most SDM models failed to encompass an interprofessional approach. Those that included at least two professionals met few of the elements of interprofessional collaboration and had limited description of SDM processes. Although models were rated as logically adequate and parsimonious, only half were tested and few were developed using an explicit process.

Practice implications

Appraisal of SDM models highlights the need for a model that is more inclusive of an interprofessional approach.

Section snippets

Background

If the focus of the 21st-century healthcare system is to be the patient, then more effort is required in clinical settings to foster patient centred care [1]. Patient centred care occurs when health professionals are respectful of and responsive to individual patient preferences and needs, and reach clinical decisions that are guided by patient values [2]. Shared decision making (SDM) can help foster patient centred care and it is particularly relevant given the increasing number of healthcare

Methods

We conducted a detailed theory analysis study of current SDM conceptual models with particular attention to those elements that are considered relevant to interprofessional collaboration. According to Walker and Avant (2005), theory analysis involves consideration of six factors: (a) the origins of development; (b) meaning as defined by the concepts and their relationships; (c) logical adequacy of concepts and their relational statements to ensure accuracy from which predictions can be made;

Results

Of 75 potential citations of SDM models, 31 were identified through 3 systematic reviews of models and/or concept analyses relating to SDM [13], [14], [15] and 44 were identified from personal files of team members involved in the larger study [19]. After removing duplicates, 54 citations were reviewed for eligibility and 23 eligible citations were included that represented 15 unique SDM models (see Fig. 1). Table 2 provides details on each of the included SDM models. Models were excluded if

Discussion

This is the first known detailed theory analysis of SDM conceptual models, frameworks and theories with a focus on an interprofessional approach. While 2 of the 15 models included the patient together with two different professionals, few of the 10 key elements of interprofessional collaboration were met within these models and when met, there was little description of the process by which health professionals share in decision making together with the patient [22], [38]. Of note is that both

Authors’ contributions

All authors participated in the identification and analysis of models. DS, FL, and SP drafted the manuscript. All authors contributed to the final version. DS is its guarantor.

Acknowledgements

ID Graham and the KT Theory Research Group for providing the theory analysis tool used in a previous study. The reviewers from Patient Education and Counseling for their suggestions to strengthen the paper.

This study was funded by the Canadian Institutes of Health Research (CIHR)—funding reference number: 200609MOP-166815-HPM-CFBA-19158 and we received two research assistant position internal grants for graduate students funded by the University of Ottawa, Faculty of Health Sciences, School of

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Medical Decision MakingShared decision making models to inform an interprofessional perspective on decision making: A theory analysis

Abstract

Objective

Methods

Results

Conclusion

Practice implications

Section snippets

Background

Methods

Results

Discussion

Authors’ contributions

Acknowledgements

Patient Educ Couns

Patient Educ Couns

Am J Prev Med

J Biomed Inform

Soc Sci Med

Patient Educ Couns

Patient Educ Couns

Am J Prev Med

Soc Sci Med

Shattuck lecture: health care in the 21st century

N Engl J Med

Crossing the quality chasm: a new health system for the 21st century

Natl Acad Sci

Framework for teaching and learning informed shared decision making

Brit Med J

Informed and shared decision-making: the crux of patient-centered care

Can Med Assoc J

Towards the ‘tipping point’: decision aids and informed patient choice

Health Affairs

Interprofessional education: effects on professional practice and health care outcomes

Cochrane Database Syst Rev

Can nurse practitioners and physicians beat parochialism into plowshares? A collaborative integrated health care workforce could improve patient care

Health Affairs

Interprofessionality as the field of interprofessional practice and interprofessional education: an emerging concept

J Interprof Care

Teamwork: a concept analysis

J Adv Nurs

Informed patient choice: patient-centered valuing of surgical risks and benefits

Health Affairs

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Medical Decision Making
Shared decision making models to inform an interprofessional perspective on decision making: A theory analysis