Key components of shared decision making models: a systematic review

Abstract

ObjectivesTo (1) provide an up-to-date overview of shared decision making (SDM)-models, (2) give insight in the prominence of components present in SDM-models, (3) describe who is identified as responsible within the components (patient, healthcare professional, both, none), (4) show the occurrence of SDM-components over time, and (5) present an SDM-map to identify SDM-components seen as key, per healthcare setting.DesignSystematic review.Eligibility criteriaPeer-reviewed articles in English presenting a new or adapted model of SDM.Information sourcesAcademic Search Premier, Cochrane, Embase, Emcare, PsycINFO, PubMed, and Web of Science were systematically searched for articles published up to and including September 2, 2019.ResultsForty articles were included, each describing a unique SDM-model. Twelve models were generic, the others were specific to a healthcare setting. Fourteen were based on empirical data, 26 primarily on analytical thinking. Fifty-three different elements were identified and clustered into 24 components. Overall, Describe treatment options was the most prominent component across models. Components present in >50% of models were: Make the decision (75%), Patient preferences (65%), Tailor information (65%), Deliberate (58%), Create choice awareness (55%), and Learn about the patient (53%). In the majority of the models (27/40), both healthcare professional and patient were identified as actors. Over time, Describe treatment options and Make the decision are the two components which are present in most models in any time period. Create choice awareness stood out for being present in a markedly larger proportion of models over time.ConclusionsThis review provides an up-to-date overview of SDM-models, showing that SDM-models quite consistently share some components but that a unified view on what SDM is, is still lacking. Clarity about what SDM constitutes is essential though for implementation, assessment, and research purposes. A map is offered to identify SDM-components seen as key.Trial registrationPROSPERO registration CRD42015019740

Measuring shared decision making in oncology: Development and first testing of the iSHAREpatient and iSHAREphysician questionnaires

“…27 We further preferred an oncology-specific questionnaire, as definitions of SDM differ between health-care settings. 5 Therefore, the present study aimed to (a) develop a patient and a physician questionnaire to measure SDM in oncology and (b) determine their content validity and comprehensibility.…”

“…To determine the SDM construct, we made a first selection of domains based on (a) an SDM model in oncology informed by the views of cancer patients, health-care professionals and SDM researchers, 11 and (b) the first search (up to June 21, 2016) for a systematic review of SDM models across settings. 5 Next, we shared the list of domains with international SDM experts and discussed it first by e-mail and then in person at the 2017 International Shared Decision Making Conference in Lyon, France.…”

“…Three items explicitly assess patient behaviour. Each item is scored on a six-point scale that ranges from 'not at all' (0) to 'completely' (5). The questionnaires include two versions of the last item, depending on whether a decision has already been made or not, in order for the questionnaires to be suitable both before and after the final treatment decision has been made.…”

“…Recent systematic reviews of SDM measurement instruments concluded that developers often do not or only vaguely define the underlying construct, and that available SDM measurement instruments substantially differ in the domains that they cover . Patient behaviour is part of SDM models,but often‐used SDM measurement instruments only assess physician behaviour (eg OPTION, CollaboRATE) or include physician behaviour when assessing patient's weighing of treatment options (eg SDM‐Q‐9, SDM‐Q‐Doc), impeding a transparent assessment of patient's role. The scope of SDM assessments is usually limited to a single consultation, while SDM extends to time outside consultations and is not confined to the space where the patient and physician meet .…”

“…At the same time, high levels of uncertainty may exist, and time is often a constraint . We further preferred an oncology‐specific questionnaire, as definitions of SDM differ between health‐care settings …”