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Development of a program theory for shared decision-making: a realist synthesis.

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  • 1Department of Community Health and Epidemiology, Health Sciences Building, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada.

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|January 25, 2020
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Summary

This study developed a program theory for Shared Decision-making (SDM), explaining how patient and provider engagement in SDM works, for whom, and in which situations. It identifies key contexts, mechanisms, and outcomes to improve healthcare decisions.

Keywords:
(3–10 words): shared decision makingHealth systemsMechanismsMedical decision makingQuality improvementRealist review

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Area of Science:

  • Health Services Research
  • Decision Science
  • Patient Engagement

Background:

  • Shared Decision-making (SDM) emerged to counter paternalistic healthcare models, aiming to better align medical choices with patient needs.
  • Despite extensive research on SDM benefits, a comprehensive theory explaining its underlying mechanisms, contextual factors, and target populations remains limited.
  • Understanding the nuances of SDM is crucial for optimizing patient-centered care and improving health outcomes.

Purpose of the Study:

  • To address the gap in theoretical understanding of Shared Decision-making (SDM).
  • To investigate the specific situations, mechanisms, and individual factors that influence effective SDM between patients and healthcare providers.
  • To develop a program theory that explains how SDM contributes to improved engagement in the decision-making process.

Main Methods:

  • A seven-step realist synthesis methodology was employed, adhering to RAMESES guidelines.
  • The process involved preliminary program theory development, comprehensive literature searches, rigorous selection and appraisal of studies, data extraction, and formal theory identification.
  • Expert consultations and stakeholder input were integrated to refine the program theory.

Main Results:

  • A program theory for SDM was developed, encompassing three key contexts: pre-existing patient-provider relationships, decision complexity, and healthcare system support.
  • Eight sets of mechanisms were identified, including patient and provider trust, self-efficacy, perception of capacity, anxiety, world view, and recognition of the decision.
  • The primary outcome identified was enhanced engagement in the Shared Decision-making process.

Conclusions:

  • This research presents the first program theory to explicate the 'how,' 'for whom,' 'in which circumstances,' and 'why' of Shared Decision-making (SDM).
  • The identified contexts and mechanisms provide a framework for understanding factors that facilitate or hinder SDM, aiding healthcare professionals, policymakers, and patients.
  • While further research is recommended, this theory offers a foundational understanding of SDM's operational principles.