Shared Decision-Making Theories, Conceptual Models, and Frameworks Within Oral Healthcare: A Theory Analysis

Area of Science:

• Oral healthcare research
• Health services research
• Decision science

Background:

• Shared decision-making (SDM) is fundamental to person-centered care in oral healthcare.
• Limited understanding exists regarding the conceptualization of patient engagement in SDM within this domain.
• Appraising existing theoretical frameworks is crucial for advancing SDM in dental practice.

Purpose of the Study:

• To critically evaluate the quality of existing theories, conceptual models, and theoretical frameworks concerning shared decision-making (SDM) in oral healthcare.
• To identify and analyze how SDM is conceptualized within the context of dental practices.
• To assess the alignment of these models with the core elements of SDM.

Main Methods:

• A comprehensive theory analysis was conducted on relevant literature.
• Systematic searches were performed across Medline, Scopus, and CINAHL databases.
• Eligible theories, conceptual models, and frameworks specifically addressing SDM in oral healthcare were analyzed using Walker and Avant's methodology and mapped against the 8 core elements of SDM.

Main Results:

• Two conceptual models specific to oral healthcare were identified from 195 citations: the SDM System on Dental Restorations (SDMS-DR) and the Four + one Habits Model (4+1 HB).
• Both models focus on the patient-professional interaction, addressing 4 (SDMS-DR) and 6 (4+1 HB) of the 8 core SDM elements, respectively.
• Key limitations include the SDMS-DR's lack of reference to patient expertise, the 4+1 HB's portrayal of SDM as linear, and neither model's empirical testing or consideration of the broader healthcare system.

Conclusions:

• Two conceptual models partially incorporating SDM elements for oral healthcare were identified.
• Neither model has undergone empirical evaluation.
• Both models exclusively focus on the patient-dentist encounter, omitting broader, multidisciplinary healthcare system considerations.