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

To appraise the quality of theories, conceptual models, and theoretical frameworks about SDM for oral healthcare practices.

Shared decision-making (SDM) is crucial to person-centred care. Yet little is known about how (and if) patient engagement in SDM is conceptualised in oral healthcare.

We conducted a theory analysis of theories, conceptual models, and frameworks. We searched Medline, Scopus, and CINAHL. Eligible theories/conceptual models/frameworks had to specifically focus on SDM in oral healthcare. Eligible papers were analysed using Walker and Avant's theory analysis steps and mapped onto the 8 core elements of SDM.

Of 195 citations, two conceptual models specific to oral healthcare were identified. The SDM System on Dental Restorations (SDMS-DR; South Korea) focuses on decisions between dentists and patients about restorative treatment. The Four + one Habits Model for dental visits (4 + 1 HB; Norway) is an approach for SDM across oral healthcare decisions, more broadly. Both conceptual models focus on the patient-professional encounter and met 4 (SDMS-DR) and 6 (4 + 1HB) of the 8 core elements of SDM. The SDMS-DR provided no reference to the patients' expertise. The 4 + 1HB presented SDM as a standardised linear process rather than a dynamic process. Neither has been empirically tested, and they do not acknowledge the broader healthcare system within which the encounters take place.

We identified two conceptual models that incorporated some elements of SDM for oral healthcare. Neither was evaluated, and both focus exclusively on the patient-oral healthcare professional encounter, without consideration of intersectional, multidisciplinary healthcare services.