Medical Decision MakingShared decision making models to inform an interprofessional perspective on decision making: A theory analysis
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
References (41)
- et al.
Barriers and facilitators to implementing shared decision-making in clinical practice: update of a systematic review of health professionals’ perceptions
Patient Educ Couns
(2008) - et al.
An integrative model of shared decision making in medical encounters
Patient Educ Couns
(2006) - et al.
Promoting informed decisions about cancer screening in communities and healthcare systems
Am J Prev Med
(2004) - et al.
Developing, implementing, and evaluating decision support systems for shared decision making in patient care: a conceptual model and case illustration
J Biomed Inform
(2002) - et al.
Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango)
Soc Sci Med
(1997) - et al.
Patient involvement in treatment decision-making: the case for a broader conceptual framework
Patient Educ Couns
(2006) - et al.
A decision aid for women considering hormone therapy after menopause: decision support framework and evaluation
Patient Educ Couns
(1998) - et al.
Shared decision making about screening and chemoprevention: a suggested approach from the U.S. Preventive Services Task Force
Am J Prev Med
(2004) - et al.
It takes three to tango: a framework for understanding patient partnership in paediatric clinics
Soc Sci Med
(2004) Shattuck lecture: health care in the 21st century
N Engl J Med
(2005)
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
Effectiveness of pre-licensure interprofessional education and post-licensure collaborative interventions
J Interprof Care
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