Shared decision making for people living with multimorbidity: A concept analysis

Area of Science:

• Health Services Research
• Patient-Centered Care
• Clinical Decision Making

Background:

• Shared decision making (SDM) is vital for patients with multimorbidity, enabling collaborative treatment choices.
• A clear conceptual understanding of SDM in multimorbidity is lacking, hindering effective patient engagement.
• This study addresses the need to define SDM for complex patient populations.

Purpose of the Study:

• To analyze the concept of shared decision making (SDM) for individuals with multimorbidity.
• To clarify the key elements and attributes of SDM in this patient group.
• To guide effective patient engagement in complex healthcare decisions.

Main Methods:

• Concept analysis using Walker and Avant's established approach.
• Comprehensive literature review to identify core components of SDM.
• Systematic examination of existing research on SDM in multimorbidity.

Main Results:

• SDM involves a partnership built on trust, multidimensional information exchange, managing complex trade-offs, and iterative communication.
• Key antecedents include disease complexity, patient needs, healthcare professional (HCP) communication skills, and health system factors.
• Consequences encompass enhanced patient autonomy, improved decision quality, increased satisfaction, symptom relief, and efficient resource utilization.

Conclusions:

• Refining the concept of SDM for multimorbidity provides a foundation for measurement tool development.
• Future research should explore practical applications of SDM beyond basic involvement.
• Healthcare systems must improve HCP communication, consultation time, policy support, and assessment tools for effective SDM implementation.