The Open Nursing Journal




ISSN: 1874-4346 ― Volume 13, 2019
REVIEW ARTICLE

Shared Decision-Making for Nursing Practice: An Integrative Review



Marie Truglio-Londrigan1, *, Jason T. Slyer2
1 Pace University, College of Health Professions, Lienhard School of Nursing 861 Bedford Road Pleasantville, NY 10570, USA
2 Clinical Assistant Professor, Pace University, College of Health Professions, Lienhard School of Nursing 163 William Street, 5th Floor New York, NY 10036, USA

Abstract

Background:

Shared decision-making has received national and international interest by providers, educators, researchers, and policy makers. The literature on shared decision-making is extensive, dealing with the individual components of shared decision-making rather than a comprehensive process. This view of shared decision-making leaves healthcare providers to wonder how to integrate shared decision-making into practice.

Objective:

To understand shared decision-making as a comprehensive process from the perspective of the patient and provider in all healthcare settings.

Methods:

An integrative review was conducted applying a systematic approach involving a literature search, data evaluation, and data analysis. The search included articles from PubMed, CINAHL, the Cochrane Central Register of Controlled Trials, and PsycINFO from 1970 through 2016. Articles included quantitative experimental and non-experimental designs, qualitative, and theoretical articles about shared decision-making between all healthcare providers and patients in all healthcare settings.

Results:

Fifty-two papers were included in this integrative review. Three categories emerged from the synthesis: (a) communication/ relationship building; (b) working towards a shared decision; and (c) action for shared decision-making. Each major theme contained sub-themes represented in the proposed visual representation for shared decision-making.

Conclusion:

A comprehensive understanding of shared decision-making between the nurse and the patient was identified. A visual representation offers a guide that depicts shared decision-making as a process taking place during a healthcare encounter with implications for the continuation of shared decisions over time offering patients an opportunity to return to the nurse for reconsiderations of past shared decisions.

Keywords: Shared decision-making, Nurse-patient relationship, Reflection, Communication, Integrative review, Practice model.


Article Information


Identifiers and Pagination:

Year: 2018
Volume: 12
First Page: 1
Last Page: 14
Publisher Id: TONURSJ-12-1
DOI: 10.2174/1874434601812010001

Article History:

Received Date: 13/10/2017
Revision Received Date: 16/12/2017
Acceptance Date: 25/12/2017
Electronic publication date: 22/1/2018
Collection year: 2018

Article Metrics:

CrossRef Citations:
0

Total Statistics:

Full-Text HTML Views: 4743
Abstract HTML Views: 1735
PDF Downloads: 1041
ePub Downloads: 1259
Total Views/Downloads: 8778

Unique Statistics:

Full-Text HTML Views: 2309
Abstract HTML Views: 808
PDF Downloads: 447
ePub Downloads: 305
Total Views/Downloads: 3869
Geographical View

© 2018 Truglio-Londrigan and Slyer.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


* Address correspondence to the author at the Pace University, College of Health Professions, Lienhard School of Nursing 861 Bedford Road Pleasantville, NY 10570, USA, Tel: (914) 773-3199; Fax: (914) 773-3357; E-mail: mlondrigan@pace.edu




1. INTRODUCTION

Shared decision-making (SDM) has received national and international attention from providers, educators, researchers, and policy makers [1Institute of Medicine. To err is human: Building a safer health system 2000.-5Salzburg Global Seminar. Salzburg statement on shared decision making 2011. Available from: http://e-patients.net/u/2011/03/ Salzburg-Statement.pdf]. Shared decision-making has been described as taking place in a relationship where there is a partnership between the provider and the patient characterized by a collaborative bi-directional mutual exchange of information and discussion involving negotiation leading to a shared decision [6Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango). Soc Sci Med 1997; 44(5): 681-92.[http://dx.doi.org/10.1016/S0277-9536(96)00221-3] [PMID: 9032835] ]. Shared decision-making, therefore, takes place in a relationship that is participatory, collaborative, open, and respectful. The relationship is one in which there are at least two participants: the nurse, as the provider, and the patient. Trust and respect between providers and patients has also been described as foundational for SDM [7Johns JL. A concept analysis of trust. J Adv Nurs 1996; 24(1): 76-83.[http://dx.doi.org/10.1046/j.1365-2648.1996.16310.x] [PMID: 8807380] -10Truglio-Londrigan M, Slyer JT, Singleton JK, Worral PS. A qualitative systematic review of internal and external influences on shared decision-making in all health care settings. JBI Database Syst Rev Implement Reports 2014; 12(5): 121-94.[http://dx.doi.org/10.11124/jbisrir-2014-1414] ].

The literature on SDM is extensive. These works describe the individual components of SDM, including the facilitators and barriers to the achievement of SDM [10Truglio-Londrigan M, Slyer JT, Singleton JK, Worral PS. A qualitative systematic review of internal and external influences on shared decision-making in all health care settings. JBI Database Syst Rev Implement Reports 2014; 12(5): 121-94.[http://dx.doi.org/10.11124/jbisrir-2014-1414] -14Peek ME, Wilson SC, Gorawara-Bhat R, Odoms-Young A, Quinn MT, Chin MH. Barriers and facilitators to shared decision-making among African-Americans with diabetes. J Gen Intern Med 2009; 24(10): 1135-9.[http://dx.doi.org/10.1007/s11606-009-1047-0] [PMID: 19578818] ]. Provider SDM competencies have also been explored in the literature [15Elwyn G, Edwards A, Wensing M, Hibbs R, Wilkinson C, Grol R. Shared decision making observed in clinical practice: visual displays of communication sequence and patterns. J Eval Clin Pract 2001; 7(2): 211-21.[http://dx.doi.org/10.1046/j.1365-2753.2001.00286.x] [PMID: 11489045] -17Truglio-Londrigan M. Practicing through a shared decision-making lens-part ii. Medsurg Nurs 2016; 25(5): 341-5.] along with the context of the provider and patient relationship such as the need for resources, including time [6Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango). Soc Sci Med 1997; 44(5): 681-92.[http://dx.doi.org/10.1016/S0277-9536(96)00221-3] [PMID: 9032835] , 18Edwards A, Elwyn G, Wood F, Atwell C, Prior L, Houston H. Shared decision making and risk communication in practice: A qualitative study of GPs’ experiences. Br J Gen Pract 2005; 55(510): 6-13.[PMID: 15667759] -29Truglio-Londrigan M. Shared decision-making in home-care from the nurse’s perspective: sitting at the kitchen table-a qualitative descriptive study. J Clin Nurs 2013; 22(19-20): 2883-95.[http://dx.doi.org/10.1111/jocn.12075] [PMID: 23331469] ]. Research has also been conducted to examine the effect of SDM on patient outcomes with regard to chronic and acute illnesses [20Friesen-Storms JH, Bours GJ, van der Weijden T, Beurskens AJ. Shared decision making in chronic care in the context of evidence based practice in nursing. Int J Nurs Stud 2015; 52(1): 393-402.[http://dx.doi.org/10.1016/j.ijnurstu.2014.06.012] [PMID: 25059684] , 27Montori VM, Gafni A, Charles C. A shared treatment decision-making approach between patients with chronic conditions and their clinicians: The case of diabetes. Health Expect 2006; 9(1): 25-36.[http://dx.doi.org/10.1111/j.1369-7625.2006.00359.x] [PMID: 16436159] , 30Deinzer A, Veelken R, Kohnen R, Schmieder RE. Is a shared decision-making approach effective in improving hypertension management? J Clin Hypertens (Greenwich) 2009; 11(5): 266-70.[http://dx.doi.org/10.1111/j.1751-7176.2009.00112.x] [PMID: 19534034] , 31Wilson SR, Strub P, Buist AS, et al. Shared treatment decision making improves adherence and outcomes in poorly controlled asthma. Am J Respir Crit Care Med 2010; 181(6): 566-77.[http://dx.doi.org/10.1164/rccm.200906-0907OC] [PMID: 20019345] ]; treatment adherence [31Wilson SR, Strub P, Buist AS, et al. Shared treatment decision making improves adherence and outcomes in poorly controlled asthma. Am J Respir Crit Care Med 2010; 181(6): 566-77.[http://dx.doi.org/10.1164/rccm.200906-0907OC] [PMID: 20019345] ]; patient coping [32Bieber C, Müller KG, Blumenstiel K, et al. Long-term effects of a shared decision-making intervention on physician-patient interaction and outcome in fibromyalgia. A qualitative and quantitative 1 year follow-up of a randomized controlled trial. Patient Educ Couns 2006; 63(3): 357-66.[http://dx.doi.org/10.1016/j.pec.2006.05.003] [PMID: 16872795] , 33van Roosmalen MS, Stalmeier PF, Verhoef LC, et al. Randomized trial of a shared decision-making intervention consisting of trade-offs and individualized treatment information for BRCA1/2 mutation carriers. J Clin Oncol 2004; 22(16): 3293-301.[http://dx.doi.org/10.1200/JCO.2004.05.066] [PMID: 15310772] ]; knowledge attainment and empowerment [34Hain DJ, Sandy D. Partners in care: Patient empowerment through shared decision-making. Nephrol Nurs J 2013; 40(2): 153-7.[PMID: 23767339] , 35Sacchi L, Rubrichi S, Rognoni C, et al. From decision to shared-decision: Introducing patients’ preferences into clinical decision analysis. Artif Intell Med 2015; 65(1): 19-28.[http://dx.doi.org/10.1016/j.artmed.2014.10.004] [PMID: 25455562] ]; autonomy and self-determination [22Hess EP, Grudzen CR, Thomson R, Raja AS, Carpenter CR. Shared decision-making in the emergency department: Respecting patient autonomy when seconds count. Acad Emerg Med 2015; 22(7): 856-64.[http://dx.doi.org/10.1111/acem.12703] , 36Christine PJ, Kaldjian LC. Communicating evidence in shared decision making. Virtual Mentor 2013; 15(1): 9-17.[http://dx.doi.org/10.1001/virtualmentor.2013.15.1.ecas1-1301] [PMID: 23356800] , 37Landmark AM, Gulbrandsen P, Svennevig J. Whose decision? Negotiating epistemic and deontic rights in medical treatment decisions. J Pragmatics 2015; 78: 54-69.[http://dx.doi.org/10.1016/j.pragma.2014.11.007] ]; and, patient satisfaction [26Mandelblatt J, Kreling B, Figeuriedo M, Feng S. What is the impact of shared decision making on treatment and outcomes for older women with breast cancer? J Clin Oncol 2006; 24(30): 4908-13.[http://dx.doi.org/10.1200/JCO.2006.07.1159] [PMID: 16983102] , 38Glass KE, Wills CE, Holloman C, et al. Shared decision making and other variables as correlates of satisfaction with health care decisions in a United States national survey. Patient Educ Couns 2012; 88(1): 100-5.[http://dx.doi.org/10.1016/j.pec.2012.02.010] [PMID: 22410642] , 39Shabason JE, Mao JJ, Frankel ES, Vapiwala N. Shared decision-making and patient control in radiation oncology: Implications for patient satisfaction. Cancer 2014; 120(12): 1863-70.[http://dx.doi.org/10.1002/cncr.28665] [PMID: 24648117] ]. Despite this research, the overall evidence as to the effect of SDM leading to positive patient outcomes is inconclusive [40Clark NM, Nelson BW, Valerio MA, Gong ZM, Taylor-Fishwick JC, Fletcher M. Consideration of shared decision making in nursing: A review of clinicians’ perceptions and interventions. Open Nurs J 2009; 3: 65-75.[http://dx.doi.org/10.2174/1874434600903010065] [PMID: 19855848] , 41Shay LA, Lafata JE. Where is the evidence? A systematic review of shared decision making and patient outcomes. Med Decis Making 2015; 35(1): 114-31.[http://dx.doi.org/10.1177/0272989X14551638] [PMID: 25351843] ].

Nurses develop relationships and work with individuals, families, communities and populations across diverse healthcare settings. Hildegard E. Peplau [42Peplau HE. Interpersonal relations in nursing 1952.] provided a framework for the nursing professions’ understanding of the nurse-patient helping relationship as the nexus from which there is growth. Millard, Hallett and Luker [43Millard L, Hallett C, Luker K. Nurse-patient interaction and decision-making in care: Patient involvement in community nursing. J Adv Nurs 2006; 55(2): 142-50.[http://dx.doi.org/10.1111/j.1365-2648.2006.03904.x] [PMID: 16866806] ] saw the importance of the nurse-patient relationship as the vehicle for the exchange of information necessary for SDM and suggested that there is a need for nurses to “pay attention to the quality and nature of the relationships they have with their patient” [43Millard L, Hallett C, Luker K. Nurse-patient interaction and decision-making in care: Patient involvement in community nursing. J Adv Nurs 2006; 55(2): 142-50.[http://dx.doi.org/10.1111/j.1365-2648.2006.03904.x] [PMID: 16866806] ]. Furthermore, Clark, et al. [40Clark NM, Nelson BW, Valerio MA, Gong ZM, Taylor-Fishwick JC, Fletcher M. Consideration of shared decision making in nursing: A review of clinicians’ perceptions and interventions. Open Nurs J 2009; 3: 65-75.[http://dx.doi.org/10.2174/1874434600903010065] [PMID: 19855848] ] examined the nurse-patient dyad as an intervention necessary to both sustain the relationship and facilitate SDM towards care management.

The focus on SDM has been on the dyad relationship and the individual components of SDM rather than describing and explaining the process taking place within the relationship. Gulbrandsen [44Gulbrandsen P. What’s in shared decision-making for the physician? Patient Educ Couns 2014; 97(2): 145-6.[http://dx.doi.org/10.1016/j.pec.2014.09.001] [PMID: 25236156] ] noted that the contemporary literature’s portrayal of SDM does not do an adequate job of illustrating the processes of SDM. A comprehensive understanding of SDM as a process would be meaningful for nurses as they work with patients towards shared decisions about care management.

2. AIM

The aim of this integrative review is to understand the comprehensive process of SDM from the perspective of the patient and provider in all healthcare settings. Understanding the process will create a common language and appreciation of SDM for meaningful nursing practice [45Herdman TH, Kamitsuru S. Nanda international nursing diagnoses: Definitions and classifiction, 2015-2017 2014.].

3. METHODS

This integrative review applied the comprehensive and systematic approach described by Whittemore and Knafl [46Whittemore R, Knafl K. The integrative review: Updated methodology. J Adv Nurs 2005; 52(5): 546-53.[http://dx.doi.org/10.1111/j.1365-2648.2005.03621.x] [PMID: 16268861] ] consisting of the literature search, data evaluation, and data analysis. This method facilitated the gathering of information and research from a variety of methodologies (quantitative, qualitative, and theoretical) supporting an integrative approach allowing for a comprehensive depiction of the process of SDM.

3.1. Inclusion Criteria

Articles considered for inclusion were qualitative or quantitative research articles or theoretical literature that addressed SDM taking place within a relationship between the patient and the provider. Patients needed to be 18 years of age or older and providers could represent any healthcare field. Only articles published in English were considered. Articles were excluded if they solely addressed intervention strategies such as education to enhance SDM competencies in providers or decision aids as an intervention to assist patients in their shared decision rather than a focus on the process of SDM taking place in a relationship. Articles focusing on shared decision-making in psychiatric or mental health settings were excluded because of the unique issues within this patient population pertaining to SDM.

3.2. Search Strategy

A comprehensive literature search was applied in PubMed, CINAHL, the Cochrane Central Register of Controlled Trials (CENTRAL), and PsycINFO. Diverse literature available in English was searched from 1970 through January 2016, including quantitative designs (both experimental and non-experimental), qualitative designs, and theoretical papers. Three searches were conducted in each database in order to identify literature related to SDM inclusive of the patient, the provider, and the environment. (Table 1) depicts these basic search strategies along with the key terms used.

Table 1
Basic search term strategies used across all databases.


3.3. Data Evaluation

Articles that met the inclusion criteria were evaluated for methodological quality. The standardized critical appraisal instruments for experimental, observations, quantitative descriptive, qualitative, and expert opinion/theoretical works from the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI-SUMARI) were used for this assessment [47Joanna briggs institute reviewers’ manual 2014 edition. 2014 edition.2014.]. This stage reduced the possibility of bias and errors by including only papers deemed reliable/dependable and valid/credible [47Joanna briggs institute reviewers’ manual 2014 edition. 2014 edition.2014.]. Any disagreements between the reviewers were resolved through discussion until consensus was reached. Supplemental (Table S1) contains the results of the critical appraisals for all included studies.

3.4. Data Analysis

Data analyses were carried out through the application of an inductive content analysis process that involved creating categories and abstractions [48Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs 2008; 62(1): 107-15.[http://dx.doi.org/10.1111/j.1365-2648.2007.04569.x] [PMID: 18352969] ]. The categories were then further grouped under higher order headings [48Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs 2008; 62(1): 107-15.[http://dx.doi.org/10.1111/j.1365-2648.2007.04569.x] [PMID: 18352969] , 49Burnard P. A method of analysing interview transcripts in qualitative research. Nurse Educ Today 1991; 11(6): 461-6.[http://dx.doi.org/10.1016/0260-6917(91)90009-Y] [PMID: 1775125] ]. The synthesis process involved creating categories that describes all of the aspects of the SDM process leading to a new representation of facts offering a visual representation of SDM as a guide for nursing practice [50Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res 2005; 15(9): 1277-88.[http://dx.doi.org/10.1177/1049732305276687] [PMID: 16204405] ].

4. RESULTS

Upon completion of the initial searches, 4,674 potentially relevant titles were identified. Duplicates were removed, leaving 1,562 articles for review. After reviewing the titles and abstracts, 1,340 articles were excluded for not meeting the inclusion criteria. After full text review, an additional 166 articles were excluded for not meet the inclusion criteria, leaving 55 articles for critical appraisal. Three articles were excluded for methodological weaknesses in the research and limited results sections (Fig. 1) [51Davis RE, Dolan G, Thomas S, et al. Exploring doctor and patient views about risk communication and shared decision-making in the consultation. Health Expect 2003; 6(3): 198-207.[http://dx.doi.org/10.1046/j.1369-6513.2003.00235.x] [PMID: 12940793] -53Stevenson FA. General practitioners’ views on shared decision making: A qualitative analysis. Patient Educ Couns 2003; 50(3): 291-3.[http://dx.doi.org/10.1016/S0738-3991(03)00052-1] [PMID: 12900102] ].

Fifty-two articles published between 1997 and 2016 were included in this review. Supplemental Table (S2) contains an overview of the included articles. Twenty-three of the articles originated from the United States, six from the United Kingdom, five from Germany, nine from Canada, two from the Netherlands, and one each from Australia, Denmark, Norway, Italy, and France. Two articles originated from multiple countries. Sixteen of the articles were quantitative designs, 19 were qualitative, one was mixed method, and 16 were conceptual.

The analysis of this integrative review and the articles retained from data analysis generated three categories: (a) communication/relationship building; (b) working towards a shared decision; and (c) action for SDM, each containing sub-themes that depict the process of SDM. (Table 2) outlines the three categories and sub-categories along with the corresponding articles informing each category. These categories and sub-categories were further contextualized into a visual representation of the shared decision-making process seen in Fig. (2).

Fig. (1)
PRISMA Flow Diagram [54Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6(7): e1000097.[http://dx.doi.org/10.1371/journal.pmed.1000097] [PMID: 19621072] ].


Table 2
Shared decision-marking categories and subcategories.


Fig. (2)
A visual representation for shared decision-making in practice.


4.1. Communication and Relationship

Communication and relationship building is the first general category and is foundational for the SDM process. The three sub-themes within this theme are: relationship building—trust and respect; information exchange— communication; and context.

4.1.1. Relationship Building—Trust and Respect

Individuals enter into the relationship and must work towards building a trusting and respectful relationship where SDM is invited and encouraged. The work begins as the patient identifies a need or question. This need and/or question influences the patient’s quest for answers [76LeBlanc A, Kenny DA, O’Connor AM, Légaré F. Decisional conflict in patients and their physicians: A dyadic approach to shared decision making. Med Decis Making 2009; 29(1): 61-8.[http://dx.doi.org/10.1177/0272989X08327067] [PMID: 19196706] ]. The relationship is the vehicle by which providers and patients “act in a relational way” and the individuals are “actively seeking a personal connection with each other” [65Lown BA, Clark WD, Hanson JL. Mutual influence in shared decision making: A collaborative study of patients and physicians. Health Expect 2009; 12(2): 160-74.[http://dx.doi.org/10.1111/j.1369-7625.2008.00525.x] [PMID: 19236633] ]. The relationship is a partnership where there is collaboration and a sharing of power [30Deinzer A, Veelken R, Kohnen R, Schmieder RE. Is a shared decision-making approach effective in improving hypertension management? J Clin Hypertens (Greenwich) 2009; 11(5): 266-70.[http://dx.doi.org/10.1111/j.1751-7176.2009.00112.x] [PMID: 19534034] , 34Hain DJ, Sandy D. Partners in care: Patient empowerment through shared decision-making. Nephrol Nurs J 2013; 40(2): 153-7.[PMID: 23767339] ]. With the sharing of power, there is mutual responsibility toward one another [16Towle A, Godolphin W, Grams G, Lamarre A. Putting informed and shared decision making into practice. Health Expect 2006; 9(4): 321-32.[http://dx.doi.org/10.1111/j.1369-7625.2006.00404.x] [PMID: 17083559] ]. The relationship is strengthened over time leading to bi-directional trust and respect [58Peek ME, Gorawara-Bhat R, Quinn MT, Odoms-Young A, Wilson SC, Chin MH. Patient trust in physicians and shared decision-making among African-Americans with diabetes. Health Commun 2013; 28(6): 616-23.[http://dx.doi.org/10.1080/10410236.2012.710873] [PMID: 23050731] , 67Shay LA, Lafata JE. Understanding patient perceptions of shared decision making. Patient Educ Couns 2014; 96(3): 295-301.[http://dx.doi.org/10.1016/j.pec.2014.07.017] [PMID: 25097150] ]. Patients who feel trusted and respected are more open and share information with their provider thereby facilitating communication for SDM [13Durif-Bruckert C, Roux P, Morelle M, Mignotte H, Faure C, Moumjid-Ferdjaoui N. Shared decision-making in medical encounters regarding breast cancer treatment: The contribution of methodological triangulation. Eur J Cancer Care 2015; 24(4): 461-72.[http://dx.doi.org/10.1111/ecc.12214] ].

4.1.2. Information Exchange—Communication

Information exchange via interpersonal and intrapersonal communication sustains the relationship. The interpersonal process of communication is bi-directional between the provider and the patient when there is a mutual exchange of information [6Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango). Soc Sci Med 1997; 44(5): 681-92.[http://dx.doi.org/10.1016/S0277-9536(96)00221-3] [PMID: 9032835] , 19Friedberg MW, Van Busum K, Wexler R, Bowen M, Schneider EC. A demonstration of shared decision making in primary care highlights barriers to adoption and potential remedies. Health Aff (Millwood) 2013; 32(2): 268-75.[http://dx.doi.org/10.1377/hlthaff.2012.1084] [PMID: 23381519] , 22Hess EP, Grudzen CR, Thomson R, Raja AS, Carpenter CR. Shared decision-making in the emergency department: Respecting patient autonomy when seconds count. Acad Emerg Med 2015; 22(7): 856-64.[http://dx.doi.org/10.1111/acem.12703] , 23Lally J, Macphail S, Palmer D, Blair E, Thomson R. Enabling patients to share decisions about their care. Nurs Times 2011; 107(34): 14-6., 25Légaré F, Witteman HO. Shared decision making: Examining key elements and barriers to adoption into routine clinical practice. Health Aff (Millwood) 2013; 32(2): 276-84.[http://dx.doi.org/10.1377/hlthaff.2012.1078] [PMID: 23381520] , 38Glass KE, Wills CE, Holloman C, et al. Shared decision making and other variables as correlates of satisfaction with health care decisions in a United States national survey. Patient Educ Couns 2012; 88(1): 100-5.[http://dx.doi.org/10.1016/j.pec.2012.02.010] [PMID: 22410642] , 67Shay LA, Lafata JE. Understanding patient perceptions of shared decision making. Patient Educ Couns 2014; 96(3): 295-301.[http://dx.doi.org/10.1016/j.pec.2014.07.017] [PMID: 25097150] , 70Siminoff LA, Step MM. A communication model of shared decision making: Accounting for cancer treatment decisions. Health Psychol 2005; 24(4S)(Suppl.): S99-S105.[http://dx.doi.org/10.1037/0278-6133.24.4.S99] [PMID: 16045427] , 72White MK, Keller V, Horrigan LA. Beyond informed consent: The shared decision making process. J Clin Outcomes Manag 2003; 10(6): 323-8.]. The exchange of information also involves active listening [29Truglio-Londrigan M. Shared decision-making in home-care from the nurse’s perspective: sitting at the kitchen table-a qualitative descriptive study. J Clin Nurs 2013; 22(19-20): 2883-95.[http://dx.doi.org/10.1111/jocn.12075] [PMID: 23331469] , 63Truglio-Londrigan M. The patient experience with shared decision making: A qualitative descriptive study. J Infus Nurs 2015; 38(6): 407-18.[http://dx.doi.org/10.1097/NAN.0000000000000136] [PMID: 26536328] , 69Saba GW, Wong ST, Schillinger D, et al. Shared decision making and the experience of partnership in primary care. Ann Fam Med 2006; 4(1): 54-62.[http://dx.doi.org/10.1370/afm.393] [PMID: 16449397] ]. Emotions such as fear, anger, and anxiety can interfere with a patient’s readiness to communicate [12Charles C, Gafni A, Whelan T. Self-reported use of shared decision-making among breast cancer specialists and perceived barriers and facilitators to implementing this approach. Health Expect 2004; 7(4): 338-48.[http://dx.doi.org/10.1111/j.1369-7625.2004.00299.x] [PMID: 15544686] , 14Peek ME, Wilson SC, Gorawara-Bhat R, Odoms-Young A, Quinn MT, Chin MH. Barriers and facilitators to shared decision-making among African-Americans with diabetes. J Gen Intern Med 2009; 24(10): 1135-9.[http://dx.doi.org/10.1007/s11606-009-1047-0] [PMID: 19578818] ]. Furthermore, a provider’s readiness and receptiveness to explore a patient’s feelings and preferences is important [65Lown BA, Clark WD, Hanson JL. Mutual influence in shared decision making: A collaborative study of patients and physicians. Health Expect 2009; 12(2): 160-74.[http://dx.doi.org/10.1111/j.1369-7625.2008.00525.x] [PMID: 19236633] ]. For example, the emotional tone the provider creates facilitates an atmosphere of compassion and caring that enhances open communication [11Bot AG, Bossen JK, Herndon JH, Ruchelsman DE, Ring D, Vranceanu AM. Informed shared decision-making and patient satisfaction. Psychosomatics 2014; 55(6): 586-94.[http://dx.doi.org/10.1016/j.psym.2013.12.013] [PMID: 24836165] , 71Thorne S, Oliffe JL, Stajduhar KI. Communicating shared decision-making: Cancer patient perspectives. Patient Educ Couns 2013; 90(3): 291-6.[http://dx.doi.org/10.1016/j.pec.2012.02.018] [PMID: 22464665] ]. In situations where this emotional tone is not created the patient is less likely to feel compassion or care and may perceive the provider’s approach as “authoritarian.” This perception may prompt the patient’s reluctance to communicate and establishing a “shield” –creating a barrier to SDM [21Frosch DL, May SG, Rendle KA, Tietbohl C, Elwyn G. Authoritarian physicians and patients’ fear of being labeled ‘difficult’ among key obstacles to shared decision making. Health Aff (Millwood) 2012; 31(5): 1030-8.[http://dx.doi.org/10.1377/hlthaff.2011.0576] [PMID: 22566443] ].

The intrapersonal process of communication also plays a role in the achievement of SDM taking place within the provider and patient through the process of reflection [73Zoffmann V, Harder I, Kirkevold M. A person-centered communication and reflection model: Sharing decision-making in chronic care. Qual Health Res 2008; 18(5): 670-85.[http://dx.doi.org/10.1177/1049732307311008] [PMID: 18223158] ]. The reflection process takes place at two levels. Mutual reflection takes place when the provider and the patient reflect together via communication, exchanging thoughts about decisions, and clarifying the patient’s perspective [73Zoffmann V, Harder I, Kirkevold M. A person-centered communication and reflection model: Sharing decision-making in chronic care. Qual Health Res 2008; 18(5): 670-85.[http://dx.doi.org/10.1177/1049732307311008] [PMID: 18223158] ]. Individual reflection takes place autonomously within the individual provider or patient [73Zoffmann V, Harder I, Kirkevold M. A person-centered communication and reflection model: Sharing decision-making in chronic care. Qual Health Res 2008; 18(5): 670-85.[http://dx.doi.org/10.1177/1049732307311008] [PMID: 18223158] ]. For example, during an individual reflective moment a provider may identify “blind spots” in a patient’s perception of an experience which may be limiting the patient’s insight about an issue [73Zoffmann V, Harder I, Kirkevold M. A person-centered communication and reflection model: Sharing decision-making in chronic care. Qual Health Res 2008; 18(5): 670-85.[http://dx.doi.org/10.1177/1049732307311008] [PMID: 18223158] ]. During the corresponding mutual reflection, the provider uses communication skills to challenge the patient verbally and non-verbally while encouraging the patient to also engage intrapersonal self-reflection. The mutual reflection process, therefore, encourages patients to engage in their own independent reflections that helps them recognize “a new decision or a new position on the difficulty or challenge on which they had been reflecting” [73Zoffmann V, Harder I, Kirkevold M. A person-centered communication and reflection model: Sharing decision-making in chronic care. Qual Health Res 2008; 18(5): 670-85.[http://dx.doi.org/10.1177/1049732307311008] [PMID: 18223158] ]. Furthermore, providers and patients continually reflect upon their relationship and communication over time known as post-decision deliberation. These deliberations offer an opportunity for reconsideration of past decisions illustrating the on-going process of decision-making [68Ford S, Schofield T, Hope T. What are the ingredients for a successful evidence-based patient choice consultation?: A qualitative study. Soc Sci Med 2003; 56(3): 589-602.[http://dx.doi.org/10.1016/S0277-9536(02)00056-4] [PMID: 12570976] ].

4.1.3. Context

The provider and the patient work within a particular healthcare context that either facilitates or creates barriers for SDM. From the patient’s perspective, the context includes the patient’s family, friends, and home, including community supports and networks [24Légaré F, St-Jacques S, Gagnon S, et al. Prenatal screening for Down syndrome: A survey of willingness in women and family physicians to engage in shared decision-making. Prenat Diagn 2011; 31(4): 319-26.[http://dx.doi.org/10.1002/pd.2624] [PMID: 21268046] , 29Truglio-Londrigan M. Shared decision-making in home-care from the nurse’s perspective: sitting at the kitchen table-a qualitative descriptive study. J Clin Nurs 2013; 22(19-20): 2883-95.[http://dx.doi.org/10.1111/jocn.12075] [PMID: 23331469] ]. For example, patients who are accompanied by family members to healthcare encounters are more likely to engage in SDM [21Frosch DL, May SG, Rendle KA, Tietbohl C, Elwyn G. Authoritarian physicians and patients’ fear of being labeled ‘difficult’ among key obstacles to shared decision making. Health Aff (Millwood) 2012; 31(5): 1030-8.[http://dx.doi.org/10.1377/hlthaff.2011.0576] [PMID: 22566443] , 26Mandelblatt J, Kreling B, Figeuriedo M, Feng S. What is the impact of shared decision making on treatment and outcomes for older women with breast cancer? J Clin Oncol 2006; 24(30): 4908-13.[http://dx.doi.org/10.1200/JCO.2006.07.1159] [PMID: 16983102] , 27Montori VM, Gafni A, Charles C. A shared treatment decision-making approach between patients with chronic conditions and their clinicians: The case of diabetes. Health Expect 2006; 9(1): 25-36.[http://dx.doi.org/10.1111/j.1369-7625.2006.00359.x] [PMID: 16436159] ]. The context of the provider’s work environment also influences their ability to integrate SDM into practice [20Friesen-Storms JH, Bours GJ, van der Weijden T, Beurskens AJ. Shared decision making in chronic care in the context of evidence based practice in nursing. Int J Nurs Stud 2015; 52(1): 393-402.[http://dx.doi.org/10.1016/j.ijnurstu.2014.06.012] [PMID: 25059684] , 22Hess EP, Grudzen CR, Thomson R, Raja AS, Carpenter CR. Shared decision-making in the emergency department: Respecting patient autonomy when seconds count. Acad Emerg Med 2015; 22(7): 856-64.[http://dx.doi.org/10.1111/acem.12703] , 23Lally J, Macphail S, Palmer D, Blair E, Thomson R. Enabling patients to share decisions about their care. Nurs Times 2011; 107(34): 14-6., 28Muthalagappan S, Johansson L, Kong WM, Brown EA. Dialysis or conservative care for frail older patients: Ethics of shared decision-making. Nephrol Dial Transplant 2013; 28(11): 2717-22.[http://dx.doi.org/10.1093/ndt/gft245] [PMID: 23787549] ]. Time and access to resources are facilitators for SDM [6Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango). Soc Sci Med 1997; 44(5): 681-92.[http://dx.doi.org/10.1016/S0277-9536(96)00221-3] [PMID: 9032835] , 18Edwards A, Elwyn G, Wood F, Atwell C, Prior L, Houston H. Shared decision making and risk communication in practice: A qualitative study of GPs’ experiences. Br J Gen Pract 2005; 55(510): 6-13.[PMID: 15667759] , 25Légaré F, Witteman HO. Shared decision making: Examining key elements and barriers to adoption into routine clinical practice. Health Aff (Millwood) 2013; 32(2): 276-84.[http://dx.doi.org/10.1377/hlthaff.2012.1078] [PMID: 23381520] , 52Edwards A, Elwyn G. Inside the black box of shared decision making: Distinguishing between the process of involvement and who makes the decision. Health Expect 2006; 9(4): 307-20.[http://dx.doi.org/10.1111/j.1369-7625.2006.00401.x] [PMID: 17083558] ]. Organizational models and systems that facilitate patients’ access to their provider(s) and/or healthcare team reduce fragmentation and improve collaboration, coordination, and SDM [25Légaré F, Witteman HO. Shared decision making: Examining key elements and barriers to adoption into routine clinical practice. Health Aff (Millwood) 2013; 32(2): 276-84.[http://dx.doi.org/10.1377/hlthaff.2012.1078] [PMID: 23381520] ]. Technology capable of tracing patients’ progress through the SDM process is a valuable resource [19Friedberg MW, Van Busum K, Wexler R, Bowen M, Schneider EC. A demonstration of shared decision making in primary care highlights barriers to adoption and potential remedies. Health Aff (Millwood) 2013; 32(2): 268-75.[http://dx.doi.org/10.1377/hlthaff.2012.1084] [PMID: 23381519] , 21Frosch DL, May SG, Rendle KA, Tietbohl C, Elwyn G. Authoritarian physicians and patients’ fear of being labeled ‘difficult’ among key obstacles to shared decision making. Health Aff (Millwood) 2012; 31(5): 1030-8.[http://dx.doi.org/10.1377/hlthaff.2011.0576] [PMID: 22566443] ]. Shared decision-making is prominent in the thoughts of healthcare providers within the larger healthcare system; however, so too are evidence-based practice (EBP) and clinical practice guidelines. The challenge for providers is to ensure that the realities of clinical practice are addressed along with the patient’s preferences [25Légaré F, Witteman HO. Shared decision making: Examining key elements and barriers to adoption into routine clinical practice. Health Aff (Millwood) 2013; 32(2): 276-84.[http://dx.doi.org/10.1377/hlthaff.2012.1078] [PMID: 23381520] ].

4.2. Work Toward Shared Decision-Making

Communication and relationship building are foundational for the initiation of SDM. Shared decision-making, however, requires dedicated ongoing work. The second general category, work towards SDM, has four sub-categories: assessment, teaching-learning, finding balance, and decision.

4.2.1. Assessment

The work towards SDM begins with an assessment. The assessment of the individual is foundational as the provider must “come to know one’s patient” [29Truglio-Londrigan M. Shared decision-making in home-care from the nurse’s perspective: sitting at the kitchen table-a qualitative descriptive study. J Clin Nurs 2013; 22(19-20): 2883-95.[http://dx.doi.org/10.1111/jocn.12075] [PMID: 23331469] ] and the patient’s specific preferences [35Sacchi L, Rubrichi S, Rognoni C, et al. From decision to shared-decision: Introducing patients’ preferences into clinical decision analysis. Artif Intell Med 2015; 65(1): 19-28.[http://dx.doi.org/10.1016/j.artmed.2014.10.004] [PMID: 25455562] ]. Understanding the individual patient characteristics begins with an awareness of the patient’s age, gender, race, spiritual and cultural beliefs, education, and life experiences. All of these characteristics influence the patient’s beliefs about SDM and the value placed on SDM [35Sacchi L, Rubrichi S, Rognoni C, et al. From decision to shared-decision: Introducing patients’ preferences into clinical decision analysis. Artif Intell Med 2015; 65(1): 19-28.[http://dx.doi.org/10.1016/j.artmed.2014.10.004] [PMID: 25455562] , 63Truglio-Londrigan M. The patient experience with shared decision making: A qualitative descriptive study. J Infus Nurs 2015; 38(6): 407-18.[http://dx.doi.org/10.1097/NAN.0000000000000136] [PMID: 26536328] ]. For example, the assessment will reveal whether patients see themselves as sharing in decision-making, or whether they prefer the provider to be the primary decision maker? The role a patient chooses to play may change over time, depending on the situation for which the patient is seeking assistance [74Charles C, Gafni A, Whelan T. Decision-making in the physician-patient encounter: Revisiting the shared treatment decision-making model. Soc Sci Med 1999; 49(5): 651-61.[http://dx.doi.org/10.1016/S0277-9536(99)00145-8] [PMID: 10452420] ]. Furthermore, as the work towards the shared decision takes place, there will be moments when the provider’s expertise will warrant that they take the lead in the encounter and other moments when the patient will take the lead [74Charles C, Gafni A, Whelan T. Decision-making in the physician-patient encounter: Revisiting the shared treatment decision-making model. Soc Sci Med 1999; 49(5): 651-61.[http://dx.doi.org/10.1016/S0277-9536(99)00145-8] [PMID: 10452420] ]. Race too may influence a patient’s behavior if an individual decides not to share information for reasons of racially inspired mistrust [58Peek ME, Gorawara-Bhat R, Quinn MT, Odoms-Young A, Wilson SC, Chin MH. Patient trust in physicians and shared decision-making among African-Americans with diabetes. Health Commun 2013; 28(6): 616-23.[http://dx.doi.org/10.1080/10410236.2012.710873] [PMID: 23050731] , 59Peek ME, Odoms-Young A, Quinn MT, Gorawara-Bhat R, Wilson SC, Chin MH. Race and shared decision-making: Perspectives of African-Americans with diabetes. Soc Sci Med 2010; 71(1): 1-9.[http://dx.doi.org/10.1016/j.socscimed.2010.03.014] [PMID: 20409625] ]. Age may influence behaviors as research has shown that younger individuals choose to engage in SDM compared to older adults [26Mandelblatt J, Kreling B, Figeuriedo M, Feng S. What is the impact of shared decision making on treatment and outcomes for older women with breast cancer? J Clin Oncol 2006; 24(30): 4908-13.[http://dx.doi.org/10.1200/JCO.2006.07.1159] [PMID: 16983102] , 28Muthalagappan S, Johansson L, Kong WM, Brown EA. Dialysis or conservative care for frail older patients: Ethics of shared decision-making. Nephrol Dial Transplant 2013; 28(11): 2717-22.[http://dx.doi.org/10.1093/ndt/gft245] [PMID: 23787549] ]. This is also true of individuals with higher levels of education and literacy [14Peek ME, Wilson SC, Gorawara-Bhat R, Odoms-Young A, Quinn MT, Chin MH. Barriers and facilitators to shared decision-making among African-Americans with diabetes. J Gen Intern Med 2009; 24(10): 1135-9.[http://dx.doi.org/10.1007/s11606-009-1047-0] [PMID: 19578818] , 25Légaré F, Witteman HO. Shared decision making: Examining key elements and barriers to adoption into routine clinical practice. Health Aff (Millwood) 2013; 32(2): 276-84.[http://dx.doi.org/10.1377/hlthaff.2012.1078] [PMID: 23381520] , 60Shalowitz DI, Wolf MS. Shared decision-making and the lower literate patient. J Law Med Ethics 2004; 32(4): 759-64.[http://dx.doi.org/10.1111/j.1748-720X.2004.tb01981.x] [PMID: 15807364] ].

The assessment continues as the provider asks questions about the reasons the patient is seeking assistance. How SDM unfolds varies depending upon the acuity or chronicity of illness [27Montori VM, Gafni A, Charles C. A shared treatment decision-making approach between patients with chronic conditions and their clinicians: The case of diabetes. Health Expect 2006; 9(1): 25-36.[http://dx.doi.org/10.1111/j.1369-7625.2006.00359.x] [PMID: 16436159] , 28Muthalagappan S, Johansson L, Kong WM, Brown EA. Dialysis or conservative care for frail older patients: Ethics of shared decision-making. Nephrol Dial Transplant 2013; 28(11): 2717-22.[http://dx.doi.org/10.1093/ndt/gft245] [PMID: 23787549] , 73Zoffmann V, Harder I, Kirkevold M. A person-centered communication and reflection model: Sharing decision-making in chronic care. Qual Health Res 2008; 18(5): 670-85.[http://dx.doi.org/10.1177/1049732307311008] [PMID: 18223158] , 75Müller-Engelmann M, Keller H, Donner-Banzhoff N, Krones T. Shared decision making in medicine: The influence of situational treatment factors. Patient Educ Couns 2011; 82(2): 240-6.[http://dx.doi.org/10.1016/j.pec.2010.04.028] [PMID: 20542403] ]. Acute illness may foster a provider-led approach to SDM. Conversely, chronic illness fosters a patient-led approach with patients who are responsible for the self-management of their illness over time in their own home/community, often with the support of family or friends [27Montori VM, Gafni A, Charles C. A shared treatment decision-making approach between patients with chronic conditions and their clinicians: The case of diabetes. Health Expect 2006; 9(1): 25-36.[http://dx.doi.org/10.1111/j.1369-7625.2006.00359.x] [PMID: 16436159] , 29Truglio-Londrigan M. Shared decision-making in home-care from the nurse’s perspective: sitting at the kitchen table-a qualitative descriptive study. J Clin Nurs 2013; 22(19-20): 2883-95.[http://dx.doi.org/10.1111/jocn.12075] [PMID: 23331469] , 39Shabason JE, Mao JJ, Frankel ES, Vapiwala N. Shared decision-making and patient control in radiation oncology: Implications for patient satisfaction. Cancer 2014; 120(12): 1863-70.[http://dx.doi.org/10.1002/cncr.28665] [PMID: 24648117] ]. Gathering information about social support and social networks, therefore, is a part of the assessment [29Truglio-Londrigan M. Shared decision-making in home-care from the nurse’s perspective: sitting at the kitchen table-a qualitative descriptive study. J Clin Nurs 2013; 22(19-20): 2883-95.[http://dx.doi.org/10.1111/jocn.12075] [PMID: 23331469] ] as these networks have been found to facilitate a patient’s ability to be active and engaged in SDM [6Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango). Soc Sci Med 1997; 44(5): 681-92.[http://dx.doi.org/10.1016/S0277-9536(96)00221-3] [PMID: 9032835] , 26Mandelblatt J, Kreling B, Figeuriedo M, Feng S. What is the impact of shared decision making on treatment and outcomes for older women with breast cancer? J Clin Oncol 2006; 24(30): 4908-13.[http://dx.doi.org/10.1200/JCO.2006.07.1159] [PMID: 16983102] ]. Ultimately, the assessment offers the provider an opportunity to know the patient, the patient’s family, and home/community, building a practice based on facts and evidence not assumptions.

4.2.2. Teaching-Learning

Shared decision-making warrants that patients have the necessary information that they need to know so that they can share in the decision-making process [78Elwyn G, Frosch D, Thomson R, et al. Shared decision making: A model for clinical practice. J Gen Intern Med 2012; 27(10): 1361-7.[http://dx.doi.org/10.1007/s11606-012-2077-6] [PMID: 22618581] ]. Providers, therefore, will need to teach and provide their patients with this information. What providers teach to support learning depends on the assessment [27Montori VM, Gafni A, Charles C. A shared treatment decision-making approach between patients with chronic conditions and their clinicians: The case of diabetes. Health Expect 2006; 9(1): 25-36.[http://dx.doi.org/10.1111/j.1369-7625.2006.00359.x] [PMID: 16436159] , 28Muthalagappan S, Johansson L, Kong WM, Brown EA. Dialysis or conservative care for frail older patients: Ethics of shared decision-making. Nephrol Dial Transplant 2013; 28(11): 2717-22.[http://dx.doi.org/10.1093/ndt/gft245] [PMID: 23787549] , 33van Roosmalen MS, Stalmeier PF, Verhoef LC, et al. Randomized trial of a shared decision-making intervention consisting of trade-offs and individualized treatment information for BRCA1/2 mutation carriers. J Clin Oncol 2004; 22(16): 3293-301.[http://dx.doi.org/10.1200/JCO.2004.05.066] [PMID: 15310772] , 74Charles C, Gafni A, Whelan T. Decision-making in the physician-patient encounter: Revisiting the shared treatment decision-making model. Soc Sci Med 1999; 49(5): 651-61.[http://dx.doi.org/10.1016/S0277-9536(99)00145-8] [PMID: 10452420] ]. For example, the provider needs to consider the readiness of the patient and the amount and type of information that needs to be taught and how to best teach that information for a specific patient [21Frosch DL, May SG, Rendle KA, Tietbohl C, Elwyn G. Authoritarian physicians and patients’ fear of being labeled ‘difficult’ among key obstacles to shared decision making. Health Aff (Millwood) 2012; 31(5): 1030-8.[http://dx.doi.org/10.1377/hlthaff.2011.0576] [PMID: 22566443] ]. This is vital in today’s EBP-driven healthcare environment. The EBP process involves sharing information with the patient about diagnosis and treatment, educating the patient about the disease and treatment options, and informing the patient about the strength of the evidence, as well as the risks, benefits, and possible outcomes [68Ford S, Schofield T, Hope T. What are the ingredients for a successful evidence-based patient choice consultation?: A qualitative study. Soc Sci Med 2003; 56(3): 589-602.[http://dx.doi.org/10.1016/S0277-9536(02)00056-4] [PMID: 12570976] ]. Information gathered during the assessment guides providers so that they are mindful of a patient’s age, literacy, language, and culture in the development and delivery of educational information. Patient-centered education applies specific teaching strategies for specific patients, such as culturally appropriate decision aids, which both guide patient learning and facilitate the patient’s understanding of information [15Elwyn G, Edwards A, Wensing M, Hibbs R, Wilkinson C, Grol R. Shared decision making observed in clinical practice: visual displays of communication sequence and patterns. J Eval Clin Pract 2001; 7(2): 211-21.[http://dx.doi.org/10.1046/j.1365-2753.2001.00286.x] [PMID: 11489045] , 27Montori VM, Gafni A, Charles C. A shared treatment decision-making approach between patients with chronic conditions and their clinicians: The case of diabetes. Health Expect 2006; 9(1): 25-36.[http://dx.doi.org/10.1111/j.1369-7625.2006.00359.x] [PMID: 16436159] , 29Truglio-Londrigan M. Shared decision-making in home-care from the nurse’s perspective: sitting at the kitchen table-a qualitative descriptive study. J Clin Nurs 2013; 22(19-20): 2883-95.[http://dx.doi.org/10.1111/jocn.12075] [PMID: 23331469] , 60Shalowitz DI, Wolf MS. Shared decision-making and the lower literate patient. J Law Med Ethics 2004; 32(4): 759-64.[http://dx.doi.org/10.1111/j.1748-720X.2004.tb01981.x] [PMID: 15807364] , 68Ford S, Schofield T, Hope T. What are the ingredients for a successful evidence-based patient choice consultation?: A qualitative study. Soc Sci Med 2003; 56(3): 589-602.[http://dx.doi.org/10.1016/S0277-9536(02)00056-4] [PMID: 12570976] , 77Peek ME, Quinn MT, Gorawara-Bhat R, Odoms-Young A, Wilson SC, Chin MH. How is shared decision-making defined among African-Americans with diabetes? Patient Educ Couns 2008; 72(3): 450-8.[http://dx.doi.org/10.1016/j.pec.2008.05.018] [PMID: 18684581] ].

4.2.3. Finding Balance

Providers and patients come together due to identified needs/issues. A need/issue causes uncertainty [76LeBlanc A, Kenny DA, O’Connor AM, Légaré F. Decisional conflict in patients and their physicians: A dyadic approach to shared decision making. Med Decis Making 2009; 29(1): 61-8.[http://dx.doi.org/10.1177/0272989X08327067] [PMID: 19196706] ] and challenges providers and patients to find a resolution through SDM. Part of the work of SDM is achieving balance necessary to arrive at a shared decision [20Friesen-Storms JH, Bours GJ, van der Weijden T, Beurskens AJ. Shared decision making in chronic care in the context of evidence based practice in nursing. Int J Nurs Stud 2015; 52(1): 393-402.[http://dx.doi.org/10.1016/j.ijnurstu.2014.06.012] [PMID: 25059684] , 37Landmark AM, Gulbrandsen P, Svennevig J. Whose decision? Negotiating epistemic and deontic rights in medical treatment decisions. J Pragmatics 2015; 78: 54-69.[http://dx.doi.org/10.1016/j.pragma.2014.11.007] ]. This is especially relevant with regard to EBP. For example, in a clinical practice scenario when there is evidence that there may be alternative best practice choices, the provider’s competence in the use of equipoise in the search for a balanced shared decision is sought. The concept of equipoise is exemplified by “talk” where there is the presentation of information, portrayal of options and exploitation of alternatives, as well as deliberation [15Elwyn G, Edwards A, Wensing M, Hibbs R, Wilkinson C, Grol R. Shared decision making observed in clinical practice: visual displays of communication sequence and patterns. J Eval Clin Pract 2001; 7(2): 211-21.[http://dx.doi.org/10.1046/j.1365-2753.2001.00286.x] [PMID: 11489045] ].

What happens, however, in situations where there is no documented evidence for best practice or there is only one best practice choice that a patient considers unacceptable because of personal ideas, values, or beliefs? These encounters invoke the ethics of practice, including the principles of autonomy and beneficence. The provider and the patient together seek to achieve balance between these principles through the application of skills such as talking, openness, and information provision [28Muthalagappan S, Johansson L, Kong WM, Brown EA. Dialysis or conservative care for frail older patients: Ethics of shared decision-making. Nephrol Dial Transplant 2013; 28(11): 2717-22.[http://dx.doi.org/10.1093/ndt/gft245] [PMID: 23787549] , 31Wilson SR, Strub P, Buist AS, et al. Shared treatment decision making improves adherence and outcomes in poorly controlled asthma. Am J Respir Crit Care Med 2010; 181(6): 566-77.[http://dx.doi.org/10.1164/rccm.200906-0907OC] [PMID: 20019345] , 36Christine PJ, Kaldjian LC. Communicating evidence in shared decision making. Virtual Mentor 2013; 15(1): 9-17.[http://dx.doi.org/10.1001/virtualmentor.2013.15.1.ecas1-1301] [PMID: 23356800] , 77Peek ME, Quinn MT, Gorawara-Bhat R, Odoms-Young A, Wilson SC, Chin MH. How is shared decision-making defined among African-Americans with diabetes? Patient Educ Couns 2008; 72(3): 450-8.[http://dx.doi.org/10.1016/j.pec.2008.05.018] [PMID: 18684581] ]. Furthermore, part of the work in finding balance requires deliberation and negotiation leading to consensus about the decision [6Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango). Soc Sci Med 1997; 44(5): 681-92.[http://dx.doi.org/10.1016/S0277-9536(96)00221-3] [PMID: 9032835] , 37Landmark AM, Gulbrandsen P, Svennevig J. Whose decision? Negotiating epistemic and deontic rights in medical treatment decisions. J Pragmatics 2015; 78: 54-69.[http://dx.doi.org/10.1016/j.pragma.2014.11.007] , 65Lown BA, Clark WD, Hanson JL. Mutual influence in shared decision making: A collaborative study of patients and physicians. Health Expect 2009; 12(2): 160-74.[http://dx.doi.org/10.1111/j.1369-7625.2008.00525.x] [PMID: 19236633] , 69Saba GW, Wong ST, Schillinger D, et al. Shared decision making and the experience of partnership in primary care. Ann Fam Med 2006; 4(1): 54-62.[http://dx.doi.org/10.1370/afm.393] [PMID: 16449397] ].

4.2.4. The Decision

Communication and relationship building, assessment, teaching and learning and the seeking of balance are all part of the SDM process leading to consensus about the decision. The work is individual for every patient and facilitates care that is patient-centered [6Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango). Soc Sci Med 1997; 44(5): 681-92.[http://dx.doi.org/10.1016/S0277-9536(96)00221-3] [PMID: 9032835] , 20Friesen-Storms JH, Bours GJ, van der Weijden T, Beurskens AJ. Shared decision making in chronic care in the context of evidence based practice in nursing. Int J Nurs Stud 2015; 52(1): 393-402.[http://dx.doi.org/10.1016/j.ijnurstu.2014.06.012] [PMID: 25059684] , 35Sacchi L, Rubrichi S, Rognoni C, et al. From decision to shared-decision: Introducing patients’ preferences into clinical decision analysis. Artif Intell Med 2015; 65(1): 19-28.[http://dx.doi.org/10.1016/j.artmed.2014.10.004] [PMID: 25455562] , 65Lown BA, Clark WD, Hanson JL. Mutual influence in shared decision making: A collaborative study of patients and physicians. Health Expect 2009; 12(2): 160-74.[http://dx.doi.org/10.1111/j.1369-7625.2008.00525.x] [PMID: 19236633] , 69Saba GW, Wong ST, Schillinger D, et al. Shared decision making and the experience of partnership in primary care. Ann Fam Med 2006; 4(1): 54-62.[http://dx.doi.org/10.1370/afm.393] [PMID: 16449397] , 74Charles C, Gafni A, Whelan T. Decision-making in the physician-patient encounter: Revisiting the shared treatment decision-making model. Soc Sci Med 1999; 49(5): 651-61.[http://dx.doi.org/10.1016/S0277-9536(99)00145-8] [PMID: 10452420] ]. Ultimately, the shared decision is not the end point but signals the need for the patient to take action and carry out the decision.

4.3. Action for Shared Decision-Making

This third theme, action for SDM, contains two sub-themes: Takes action or no action.

4.3.1. Takes Action

Shared decision-making does not end with the decision. Once the provider and patient come to a shared decision there needs to be action by the patient. The process of SDM, therefore, moves beyond the decision point as the patient engages in the steps necessary to take action to see the decision through [73Zoffmann V, Harder I, Kirkevold M. A person-centered communication and reflection model: Sharing decision-making in chronic care. Qual Health Res 2008; 18(5): 670-85.[http://dx.doi.org/10.1177/1049732307311008] [PMID: 18223158] ]. For example, patients return to their homes/communities where they attempt to carry out their decisions. During this process, the implementation of the decision may be seamless, the patient is satisfied, and the issue or question is addressed. There may be, however, times when patients find the action challenging or the actions that are required are not what was expected. In these situations, the patient may not be satisfied resulting in an unresolved issue or questions prompting the patient to return to the provider to re-evaluate the decision [13Durif-Bruckert C, Roux P, Morelle M, Mignotte H, Faure C, Moumjid-Ferdjaoui N. Shared decision-making in medical encounters regarding breast cancer treatment: The contribution of methodological triangulation. Eur J Cancer Care 2015; 24(4): 461-72.[http://dx.doi.org/10.1111/ecc.12214] , 19Friedberg MW, Van Busum K, Wexler R, Bowen M, Schneider EC. A demonstration of shared decision making in primary care highlights barriers to adoption and potential remedies. Health Aff (Millwood) 2013; 32(2): 268-75.[http://dx.doi.org/10.1377/hlthaff.2012.1084] [PMID: 23381519] , 21Frosch DL, May SG, Rendle KA, Tietbohl C, Elwyn G. Authoritarian physicians and patients’ fear of being labeled ‘difficult’ among key obstacles to shared decision making. Health Aff (Millwood) 2012; 31(5): 1030-8.[http://dx.doi.org/10.1377/hlthaff.2011.0576] [PMID: 22566443] , 27Montori VM, Gafni A, Charles C. A shared treatment decision-making approach between patients with chronic conditions and their clinicians: The case of diabetes. Health Expect 2006; 9(1): 25-36.[http://dx.doi.org/10.1111/j.1369-7625.2006.00359.x] [PMID: 16436159] , 63Truglio-Londrigan M. The patient experience with shared decision making: A qualitative descriptive study. J Infus Nurs 2015; 38(6): 407-18.[http://dx.doi.org/10.1097/NAN.0000000000000136] [PMID: 26536328] , 68Ford S, Schofield T, Hope T. What are the ingredients for a successful evidence-based patient choice consultation?: A qualitative study. Soc Sci Med 2003; 56(3): 589-602.[http://dx.doi.org/10.1016/S0277-9536(02)00056-4] [PMID: 12570976] , 73Zoffmann V, Harder I, Kirkevold M. A person-centered communication and reflection model: Sharing decision-making in chronic care. Qual Health Res 2008; 18(5): 670-85.[http://dx.doi.org/10.1177/1049732307311008] [PMID: 18223158] ].

4.3.2. No Action

No action occurs when patients return to their homes/communities; however, once in their familiar environment, they chose not to initiate the steps and actions to see their decisions through. For example, patients may feel pressured by the perceived power imbalance they experienced with their provider and as a result found themselves aligning with a particular decision favored by the provider [21Frosch DL, May SG, Rendle KA, Tietbohl C, Elwyn G. Authoritarian physicians and patients’ fear of being labeled ‘difficult’ among key obstacles to shared decision making. Health Aff (Millwood) 2012; 31(5): 1030-8.[http://dx.doi.org/10.1377/hlthaff.2011.0576] [PMID: 22566443] , 34Hain DJ, Sandy D. Partners in care: Patient empowerment through shared decision-making. Nephrol Nurs J 2013; 40(2): 153-7.[PMID: 23767339] ]. As a result, when patients return to their homes/communities they choose not to act. This realization may trigger the need to return to the provider or in some cases a patient may choose not to return for further care [13Durif-Bruckert C, Roux P, Morelle M, Mignotte H, Faure C, Moumjid-Ferdjaoui N. Shared decision-making in medical encounters regarding breast cancer treatment: The contribution of methodological triangulation. Eur J Cancer Care 2015; 24(4): 461-72.[http://dx.doi.org/10.1111/ecc.12214] , 19Friedberg MW, Van Busum K, Wexler R, Bowen M, Schneider EC. A demonstration of shared decision making in primary care highlights barriers to adoption and potential remedies. Health Aff (Millwood) 2013; 32(2): 268-75.[http://dx.doi.org/10.1377/hlthaff.2012.1084] [PMID: 23381519] , 21Frosch DL, May SG, Rendle KA, Tietbohl C, Elwyn G. Authoritarian physicians and patients’ fear of being labeled ‘difficult’ among key obstacles to shared decision making. Health Aff (Millwood) 2012; 31(5): 1030-8.[http://dx.doi.org/10.1377/hlthaff.2011.0576] [PMID: 22566443] , 27Montori VM, Gafni A, Charles C. A shared treatment decision-making approach between patients with chronic conditions and their clinicians: The case of diabetes. Health Expect 2006; 9(1): 25-36.[http://dx.doi.org/10.1111/j.1369-7625.2006.00359.x] [PMID: 16436159] , 63Truglio-Londrigan M. The patient experience with shared decision making: A qualitative descriptive study. J Infus Nurs 2015; 38(6): 407-18.[http://dx.doi.org/10.1097/NAN.0000000000000136] [PMID: 26536328] , 68Ford S, Schofield T, Hope T. What are the ingredients for a successful evidence-based patient choice consultation?: A qualitative study. Soc Sci Med 2003; 56(3): 589-602.[http://dx.doi.org/10.1016/S0277-9536(02)00056-4] [PMID: 12570976] , 73Zoffmann V, Harder I, Kirkevold M. A person-centered communication and reflection model: Sharing decision-making in chronic care. Qual Health Res 2008; 18(5): 670-85.[http://dx.doi.org/10.1177/1049732307311008] [PMID: 18223158] ].

5. DISCUSSION

The significance of this integrative review is noted in the presentation of the ongoing process of SDM. Box (1) below provides a case study that exemplifies this ongoing process. This process takes place in practice between a nurse and patient during a healthcare encounter where there is an identified need/issue or question. The relationship is one of a partnership where both parties are collaborating. The relationship that develops is one where trust and respect is fostered by the communication between the nurse and the patient. Communication is both interpersonal and intrapersonal. Interpersonal communication between the nurse and patient takes place during the healthcare encounter. Intrapersonal communication takes place during the encounter when the nurse and patient think about—viareflection—what they are saying, doing, and observing at the moment they are actively engaged [79Schon DA. The reflective practitioner: How professionals think in action 1st ed. 1st ed.1984.]. For example, a nurse may reflect on a patient’s non-responsiveness to a conversation. Nurses who are knowledgeable about communication and skillful in the application of communication techniques will use strategic questioning where options are explored and listening to facilitate a patient’s insight into the presiding issue [80Smith SK, Dixon A, Trevena L, Nutbeam D, McCaffery KJ. Exploring patient involvement in healthcare decision making across different education and functional health literacy groups. Soc Sci Med 2009; 69(12): 1805-12.[http://dx.doi.org/10.1016/j.socscimed.2009.09.056] [PMID: 19846245] ]. Reflection also continues after the interaction as nurses and patients reflect upon past SDM healthcare encounters. During these moments, patients may have questions and/or decide that the initial decision is no longer acceptable and wish to return to their nurse. This review highlights relationship building and communication in nursing practice that is foundational for SDM and signals that communication is complex, requiring nurses to be ever vigilant about what they are saying and doing, as well as the patient’s response. Being aware of one’s own reflections as well as one’s skills to assist patients in their own self-reflection facilitates a practice based in SDM. In addition, this review highlights the need for a practice environment that fosters relationships and communication by establishing practice models where ongoing connections between the nurse and patient are consistent and continuous, thereby supporting and sustaining SDM.

Box 1
A case study of shared decision-making.


Flexibility in the nurse-patient relationship is identified as significant in this review and takes place as nurses and patients work together, alternating who takes the lead during SDM. There may be times when the nurse takes the lead to educate the patient about best practices while considering patient characteristics and the patient’s response to the information. As the work continues, the patient may take the lead, being the expert in his/her own life experiences. Flexibility in the SDM process also takes place in the bi-directional communication between the nurse and the patient as discussions take place about EBP. These discussions are a give and take of ideas about EBP and choices about treatments; when balance is achieved, a shared decision can be reached.

This review also highlights the need for nurses to be continually aware of the importance of context in the form of family/friends, community, organization, and the greater healthcare system. For example, practice models that are intra and interprofessionally based will enhance patients’ access to available organizational providers in the event they need to return to re-evaluate a past decision. These practice models also enrich the support, guidance, teaching, and mentoring of patients [23Lally J, Macphail S, Palmer D, Blair E, Thomson R. Enabling patients to share decisions about their care. Nurs Times 2011; 107(34): 14-6., 25Légaré F, Witteman HO. Shared decision making: Examining key elements and barriers to adoption into routine clinical practice. Health Aff (Millwood) 2013; 32(2): 276-84.[http://dx.doi.org/10.1377/hlthaff.2012.1078] [PMID: 23381520] , 27Montori VM, Gafni A, Charles C. A shared treatment decision-making approach between patients with chronic conditions and their clinicians: The case of diabetes. Health Expect 2006; 9(1): 25-36.[http://dx.doi.org/10.1111/j.1369-7625.2006.00359.x] [PMID: 16436159] , 29Truglio-Londrigan M. Shared decision-making in home-care from the nurse’s perspective: sitting at the kitchen table-a qualitative descriptive study. J Clin Nurs 2013; 22(19-20): 2883-95.[http://dx.doi.org/10.1111/jocn.12075] [PMID: 23331469] ]. Resources that foster and facilitate SDM such as time, consultation services, reliable and valid decision aids that are culturally appropriate, and clinical information systems that track a patient’s progress in the achievement of shared decisions are necessary. These examples suggest policy changes at the organizational level. At the healthcare system level, the development of standards of practice based in evidence, while beneficial, have been viewed as a challenge by others as there may be the potential for “fewer choices being offered to patients by healthcare providers” [25Légaré F, Witteman HO. Shared decision making: Examining key elements and barriers to adoption into routine clinical practice. Health Aff (Millwood) 2013; 32(2): 276-84.[http://dx.doi.org/10.1377/hlthaff.2012.1078] [PMID: 23381520] ].

Education initiatives that enhance the nurse’s ability to integrate SDM into their practice are significant. Competencies need to be achieved in the area of reflective practice, the nurse-patient relationship, communication and strategic questioning, assessment, teaching and learning, ethics, and the role of social supports and social networks within a community. Part of this educational endeavor also includes nurses examining their own comfort levels about SDM. For example, nurses may express positive beliefs about SDM; however, these beliefs may not manifest in practice as the nurse may be ambivalent about a partnership with a patient due to a lack of trust in a patient’s ability [16Towle A, Godolphin W, Grams G, Lamarre A. Putting informed and shared decision making into practice. Health Expect 2006; 9(4): 321-32.[http://dx.doi.org/10.1111/j.1369-7625.2006.00404.x] [PMID: 17083559] , 64Upton J, Fletcher M, Madoc-Sutton H, Sheikh A, Caress A-L, Walker S. Shared decision making or paternalism in nursing consultations? A qualitative study of primary care asthma nurses’ views on sharing decisions with patients regarding inhaler device selection. Health Expect 2011; 14(4): 374-82.[http://dx.doi.org/10.1111/j.1369-7625.2010.00653.x] [PMID: 21323822] ]. Patents too will need to be competent in order to be active and engaged in the SDM process. Their competency, however, is centered around the information that they need to know to participate in SDM. This means that the SDM encounter will require that nurses provide support, guidance, mentoring, coordination, and education to patients throughout the entire SDM process. Nurses, therefore, will need to assume a diverse set of roles beyond caregiver as they adjust to the flexible nature of SDM. For example, the shared decision may require a course of action in which the patient needs to access community resources. Nurses will educate patients on what community resources are available, offer advice and support patients as they access services, and advocate when a patient has difficulty connecting with these services.

The visual representation of SDM Fig. (2) offered in this review provides nurses with a guide for practice and also for research. Contemplating the guide offers cues for hypothesis generation and the raising of qualitative questions that will add to the body of nursing knowledge. For example, there is limited information in the literature about patients returning to their home/communities as they attempt to take the necessary steps and carry out the actions for the shared decision. The development of qualitative descriptive studies to describe what happens as patients attempts to initiate shared decisions once they leave a healthcare encounter would provide valuable evidence for nurses as they address needed practice changes to facilitate SDM.

CONCLUSION

Shared decision-making has received attention in the recent years, however, this attention has focused on the individual components of SDM rather than a comprehensive process. An understanding of SDM that captures this comprehensive process would facilitate SDM in practice, research, and the development of educational programs for nurses and other healthcare providers that embrace all aspects of the process. To this end, an integrative review was conducted applying the systematic approach described by Whittemore and Knafl [46Whittemore R, Knafl K. The integrative review: Updated methodology. J Adv Nurs 2005; 52(5): 546-53.[http://dx.doi.org/10.1111/j.1365-2648.2005.03621.x] [PMID: 16268861] ]. The outcome of this integrative review provides an understanding of SDM as a comprehensive process that takes place between the nurse and the patient. It provides an opportunity to consider the complexity of SDM as an on-going process that does not end with the decision. The visual representation is a guide that depicts the processes of SDM taking place during the healthcare encounter with implications for the shared decision over time in the event a patient needs to return to the nurse to reconsider earlier decisions.

LIST OF ABBREVIATIONS

CENTRAL Cochrane Central Register of Controlled Trials
EBP Evidence-based practice
JBI-SUMARI Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information
SDM Shared Decision-making

CONSENT FOR PUBLICATION

Not applicable.

CONFLICT OF INTEREST

The authors declare no conflict of interest, financial or otherwise.

ACKNOWLEDGEMENTS

Declared none.

SUPPLEMENTARY MATERIAL

Supplementary material is available on the publishers Website along with the published article.

Download File


REFERENCES

[1] Institute of Medicine. To err is human: Building a safer health system 2000.
[2] Institute of Medicine. Crossing the quality chasm: A new health system for the 21st century 2001.
[3] Patient Protection and Affordable Care Act. Section 3506 of the ppaca amended in section 936 [42 u. S. C. 299b-36] and titled- program to facilitate shared decisionmaking. [Internet] 2010. Available from: http://www.gpo.gov/fdsys/pkg/ PLAW-111publ148/pdf/ PLAW-111publ148.pdf 2010.
[4] Coulter A, Collins A. Making shared decision-making a reality: No decision about me, without me 2011.
[5] Salzburg Global Seminar. Salzburg statement on shared decision making 2011. Available from: http://e-patients.net/u/2011/03/ Salzburg-Statement.pdf
[6] Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango). Soc Sci Med 1997; 44(5): 681-92.[http://dx.doi.org/10.1016/S0277-9536(96)00221-3] [PMID: 9032835]
[7] Johns JL. A concept analysis of trust. J Adv Nurs 1996; 24(1): 76-83.[http://dx.doi.org/10.1046/j.1365-2648.1996.16310.x] [PMID: 8807380]
[8] Matthias MS, Salyers MP, Frankel RM. Re-thinking shared decision-making: Context matters. Patient Educ Couns 2013; 91(2): 176-9.[http://dx.doi.org/10.1016/j.pec.2013.01.006] [PMID: 23410979]
[9] Truglio-Londrigan M. Shared decision-making in home-care from the nurse’s perspective: Sitting at the kitchen table-a qualitative descriptive study. J Clin Nurs 2013; 22(19-20): 2883-95.[http://dx.doi.org/10.1111/jocn.12075] [PMID: 23331469]
[10] Truglio-Londrigan M, Slyer JT, Singleton JK, Worral PS. A qualitative systematic review of internal and external influences on shared decision-making in all health care settings. JBI Database Syst Rev Implement Reports 2014; 12(5): 121-94.[http://dx.doi.org/10.11124/jbisrir-2014-1414]
[11] Bot AG, Bossen JK, Herndon JH, Ruchelsman DE, Ring D, Vranceanu AM. Informed shared decision-making and patient satisfaction. Psychosomatics 2014; 55(6): 586-94.[http://dx.doi.org/10.1016/j.psym.2013.12.013] [PMID: 24836165]
[12] Charles C, Gafni A, Whelan T. Self-reported use of shared decision-making among breast cancer specialists and perceived barriers and facilitators to implementing this approach. Health Expect 2004; 7(4): 338-48.[http://dx.doi.org/10.1111/j.1369-7625.2004.00299.x] [PMID: 15544686]
[13] Durif-Bruckert C, Roux P, Morelle M, Mignotte H, Faure C, Moumjid-Ferdjaoui N. Shared decision-making in medical encounters regarding breast cancer treatment: The contribution of methodological triangulation. Eur J Cancer Care 2015; 24(4): 461-72.[http://dx.doi.org/10.1111/ecc.12214]
[14] Peek ME, Wilson SC, Gorawara-Bhat R, Odoms-Young A, Quinn MT, Chin MH. Barriers and facilitators to shared decision-making among African-Americans with diabetes. J Gen Intern Med 2009; 24(10): 1135-9.[http://dx.doi.org/10.1007/s11606-009-1047-0] [PMID: 19578818]
[15] Elwyn G, Edwards A, Wensing M, Hibbs R, Wilkinson C, Grol R. Shared decision making observed in clinical practice: visual displays of communication sequence and patterns. J Eval Clin Pract 2001; 7(2): 211-21.[http://dx.doi.org/10.1046/j.1365-2753.2001.00286.x] [PMID: 11489045]
[16] Towle A, Godolphin W, Grams G, Lamarre A. Putting informed and shared decision making into practice. Health Expect 2006; 9(4): 321-32.[http://dx.doi.org/10.1111/j.1369-7625.2006.00404.x] [PMID: 17083559]
[17] Truglio-Londrigan M. Practicing through a shared decision-making lens-part ii. Medsurg Nurs 2016; 25(5): 341-5.
[18] Edwards A, Elwyn G, Wood F, Atwell C, Prior L, Houston H. Shared decision making and risk communication in practice: A qualitative study of GPs’ experiences. Br J Gen Pract 2005; 55(510): 6-13.[PMID: 15667759]
[19] Friedberg MW, Van Busum K, Wexler R, Bowen M, Schneider EC. A demonstration of shared decision making in primary care highlights barriers to adoption and potential remedies. Health Aff (Millwood) 2013; 32(2): 268-75.[http://dx.doi.org/10.1377/hlthaff.2012.1084] [PMID: 23381519]
[20] Friesen-Storms JH, Bours GJ, van der Weijden T, Beurskens AJ. Shared decision making in chronic care in the context of evidence based practice in nursing. Int J Nurs Stud 2015; 52(1): 393-402.[http://dx.doi.org/10.1016/j.ijnurstu.2014.06.012] [PMID: 25059684]
[21] Frosch DL, May SG, Rendle KA, Tietbohl C, Elwyn G. Authoritarian physicians and patients’ fear of being labeled ‘difficult’ among key obstacles to shared decision making. Health Aff (Millwood) 2012; 31(5): 1030-8.[http://dx.doi.org/10.1377/hlthaff.2011.0576] [PMID: 22566443]
[22] Hess EP, Grudzen CR, Thomson R, Raja AS, Carpenter CR. Shared decision-making in the emergency department: Respecting patient autonomy when seconds count. Acad Emerg Med 2015; 22(7): 856-64.[http://dx.doi.org/10.1111/acem.12703]
[23] Lally J, Macphail S, Palmer D, Blair E, Thomson R. Enabling patients to share decisions about their care. Nurs Times 2011; 107(34): 14-6.
[24] Légaré F, St-Jacques S, Gagnon S, et al. Prenatal screening for Down syndrome: A survey of willingness in women and family physicians to engage in shared decision-making. Prenat Diagn 2011; 31(4): 319-26.[http://dx.doi.org/10.1002/pd.2624] [PMID: 21268046]
[25] Légaré F, Witteman HO. Shared decision making: Examining key elements and barriers to adoption into routine clinical practice. Health Aff (Millwood) 2013; 32(2): 276-84.[http://dx.doi.org/10.1377/hlthaff.2012.1078] [PMID: 23381520]
[26] Mandelblatt J, Kreling B, Figeuriedo M, Feng S. What is the impact of shared decision making on treatment and outcomes for older women with breast cancer? J Clin Oncol 2006; 24(30): 4908-13.[http://dx.doi.org/10.1200/JCO.2006.07.1159] [PMID: 16983102]
[27] Montori VM, Gafni A, Charles C. A shared treatment decision-making approach between patients with chronic conditions and their clinicians: The case of diabetes. Health Expect 2006; 9(1): 25-36.[http://dx.doi.org/10.1111/j.1369-7625.2006.00359.x] [PMID: 16436159]
[28] Muthalagappan S, Johansson L, Kong WM, Brown EA. Dialysis or conservative care for frail older patients: Ethics of shared decision-making. Nephrol Dial Transplant 2013; 28(11): 2717-22.[http://dx.doi.org/10.1093/ndt/gft245] [PMID: 23787549]
[29] Truglio-Londrigan M. Shared decision-making in home-care from the nurse’s perspective: sitting at the kitchen table-a qualitative descriptive study. J Clin Nurs 2013; 22(19-20): 2883-95.[http://dx.doi.org/10.1111/jocn.12075] [PMID: 23331469]
[30] Deinzer A, Veelken R, Kohnen R, Schmieder RE. Is a shared decision-making approach effective in improving hypertension management? J Clin Hypertens (Greenwich) 2009; 11(5): 266-70.[http://dx.doi.org/10.1111/j.1751-7176.2009.00112.x] [PMID: 19534034]
[31] Wilson SR, Strub P, Buist AS, et al. Shared treatment decision making improves adherence and outcomes in poorly controlled asthma. Am J Respir Crit Care Med 2010; 181(6): 566-77.[http://dx.doi.org/10.1164/rccm.200906-0907OC] [PMID: 20019345]
[32] Bieber C, Müller KG, Blumenstiel K, et al. Long-term effects of a shared decision-making intervention on physician-patient interaction and outcome in fibromyalgia. A qualitative and quantitative 1 year follow-up of a randomized controlled trial. Patient Educ Couns 2006; 63(3): 357-66.[http://dx.doi.org/10.1016/j.pec.2006.05.003] [PMID: 16872795]
[33] van Roosmalen MS, Stalmeier PF, Verhoef LC, et al. Randomized trial of a shared decision-making intervention consisting of trade-offs and individualized treatment information for BRCA1/2 mutation carriers. J Clin Oncol 2004; 22(16): 3293-301.[http://dx.doi.org/10.1200/JCO.2004.05.066] [PMID: 15310772]
[34] Hain DJ, Sandy D. Partners in care: Patient empowerment through shared decision-making. Nephrol Nurs J 2013; 40(2): 153-7.[PMID: 23767339]
[35] Sacchi L, Rubrichi S, Rognoni C, et al. From decision to shared-decision: Introducing patients’ preferences into clinical decision analysis. Artif Intell Med 2015; 65(1): 19-28.[http://dx.doi.org/10.1016/j.artmed.2014.10.004] [PMID: 25455562]
[36] Christine PJ, Kaldjian LC. Communicating evidence in shared decision making. Virtual Mentor 2013; 15(1): 9-17.[http://dx.doi.org/10.1001/virtualmentor.2013.15.1.ecas1-1301] [PMID: 23356800]
[37] Landmark AM, Gulbrandsen P, Svennevig J. Whose decision? Negotiating epistemic and deontic rights in medical treatment decisions. J Pragmatics 2015; 78: 54-69.[http://dx.doi.org/10.1016/j.pragma.2014.11.007]
[38] Glass KE, Wills CE, Holloman C, et al. Shared decision making and other variables as correlates of satisfaction with health care decisions in a United States national survey. Patient Educ Couns 2012; 88(1): 100-5.[http://dx.doi.org/10.1016/j.pec.2012.02.010] [PMID: 22410642]
[39] Shabason JE, Mao JJ, Frankel ES, Vapiwala N. Shared decision-making and patient control in radiation oncology: Implications for patient satisfaction. Cancer 2014; 120(12): 1863-70.[http://dx.doi.org/10.1002/cncr.28665] [PMID: 24648117]
[40] Clark NM, Nelson BW, Valerio MA, Gong ZM, Taylor-Fishwick JC, Fletcher M. Consideration of shared decision making in nursing: A review of clinicians’ perceptions and interventions. Open Nurs J 2009; 3: 65-75.[http://dx.doi.org/10.2174/1874434600903010065] [PMID: 19855848]
[41] Shay LA, Lafata JE. Where is the evidence? A systematic review of shared decision making and patient outcomes. Med Decis Making 2015; 35(1): 114-31.[http://dx.doi.org/10.1177/0272989X14551638] [PMID: 25351843]
[42] Peplau HE. Interpersonal relations in nursing 1952.
[43] Millard L, Hallett C, Luker K. Nurse-patient interaction and decision-making in care: Patient involvement in community nursing. J Adv Nurs 2006; 55(2): 142-50.[http://dx.doi.org/10.1111/j.1365-2648.2006.03904.x] [PMID: 16866806]
[44] Gulbrandsen P. What’s in shared decision-making for the physician? Patient Educ Couns 2014; 97(2): 145-6.[http://dx.doi.org/10.1016/j.pec.2014.09.001] [PMID: 25236156]
[45] Herdman TH, Kamitsuru S. Nanda international nursing diagnoses: Definitions and classifiction, 2015-2017 2014.
[46] Whittemore R, Knafl K. The integrative review: Updated methodology. J Adv Nurs 2005; 52(5): 546-53.[http://dx.doi.org/10.1111/j.1365-2648.2005.03621.x] [PMID: 16268861]
[47] Joanna briggs institute reviewers’ manual 2014 edition. 2014 edition.2014.
[48] Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs 2008; 62(1): 107-15.[http://dx.doi.org/10.1111/j.1365-2648.2007.04569.x] [PMID: 18352969]
[49] Burnard P. A method of analysing interview transcripts in qualitative research. Nurse Educ Today 1991; 11(6): 461-6.[http://dx.doi.org/10.1016/0260-6917(91)90009-Y] [PMID: 1775125]
[50] Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res 2005; 15(9): 1277-88.[http://dx.doi.org/10.1177/1049732305276687] [PMID: 16204405]
[51] Davis RE, Dolan G, Thomas S, et al. Exploring doctor and patient views about risk communication and shared decision-making in the consultation. Health Expect 2003; 6(3): 198-207.[http://dx.doi.org/10.1046/j.1369-6513.2003.00235.x] [PMID: 12940793]
[52] Edwards A, Elwyn G. Inside the black box of shared decision making: Distinguishing between the process of involvement and who makes the decision. Health Expect 2006; 9(4): 307-20.[http://dx.doi.org/10.1111/j.1369-7625.2006.00401.x] [PMID: 17083558]
[53] Stevenson FA. General practitioners’ views on shared decision making: A qualitative analysis. Patient Educ Couns 2003; 50(3): 291-3.[http://dx.doi.org/10.1016/S0738-3991(03)00052-1] [PMID: 12900102]
[54] Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6(7): e1000097.[http://dx.doi.org/10.1371/journal.pmed.1000097] [PMID: 19621072]
[55] Bernhard J, Butow P, Aldridge J, Juraskova I, Ribi K, Brown R. Communication about standard treatment options and clinical trials: Can we teach doctors new skills to improve patient outcomes? Psychooncology 2012; 21(12): 1265-74.[http://dx.doi.org/10.1002/pon.2044] [PMID: 23208837]
[56] Charles C, Gafni A, Whelan T, O’Brien MA. Cultural influences on the physician-patient encounter: The case of shared treatment decision-making. Patient Educ Couns 2006; 63(3): 262-7.[http://dx.doi.org/10.1016/j.pec.2006.06.018] [PMID: 17000073]
[57] Isaacs CG, Kistler C, Hunold KM, et al. Shared decision-making in the selection of outpatient analgesics for older individuals in the emergency department. J Am Geriatr Soc 2013; 61(5): 793-8.[http://dx.doi.org/10.1111/jgs.12207] [PMID: 23590177]
[58] Peek ME, Gorawara-Bhat R, Quinn MT, Odoms-Young A, Wilson SC, Chin MH. Patient trust in physicians and shared decision-making among African-Americans with diabetes. Health Commun 2013; 28(6): 616-23.[http://dx.doi.org/10.1080/10410236.2012.710873] [PMID: 23050731]
[59] Peek ME, Odoms-Young A, Quinn MT, Gorawara-Bhat R, Wilson SC, Chin MH. Race and shared decision-making: Perspectives of African-Americans with diabetes. Soc Sci Med 2010; 71(1): 1-9.[http://dx.doi.org/10.1016/j.socscimed.2010.03.014] [PMID: 20409625]
[60] Shalowitz DI, Wolf MS. Shared decision-making and the lower literate patient. J Law Med Ethics 2004; 32(4): 759-64.[http://dx.doi.org/10.1111/j.1748-720X.2004.tb01981.x] [PMID: 15807364]
[61] Smith A, Juraskova I, Butow P, et al. Sharing vs. caring--the relative impact of sharing decisions versus managing emotions on patient outcomes. Patient Educ Couns 2011; 82(2): 233-9.[http://dx.doi.org/10.1016/j.pec.2010.04.001] [PMID: 20434865]
[62] Tinsel I, Buchholz A, Vach W, et al. Shared decision-making in antihypertensive therapy: A cluster randomised controlled trial. BMC Fam Pract 2013; 14: 135.[http://dx.doi.org/10.1186/1471-2296-14-135] [PMID: 24024587]
[63] Truglio-Londrigan M. The patient experience with shared decision making: A qualitative descriptive study. J Infus Nurs 2015; 38(6): 407-18.[http://dx.doi.org/10.1097/NAN.0000000000000136] [PMID: 26536328]
[64] Upton J, Fletcher M, Madoc-Sutton H, Sheikh A, Caress A-L, Walker S. Shared decision making or paternalism in nursing consultations? A qualitative study of primary care asthma nurses’ views on sharing decisions with patients regarding inhaler device selection. Health Expect 2011; 14(4): 374-82.[http://dx.doi.org/10.1111/j.1369-7625.2010.00653.x] [PMID: 21323822]
[65] Lown BA, Clark WD, Hanson JL. Mutual influence in shared decision making: A collaborative study of patients and physicians. Health Expect 2009; 12(2): 160-74.[http://dx.doi.org/10.1111/j.1369-7625.2008.00525.x] [PMID: 19236633]
[66] Ommen O, Thuem S, Pfaff H, Janssen C. The relationship between social support, shared decision-making and patient’s trust in doctors: A cross-sectional survey of 2,197 inpatients using the Cologne Patient Questionnaire. Int J Public Health 2011; 56(3): 319-27.[http://dx.doi.org/10.1007/s00038-010-0212-x] [PMID: 21076932]
[67] Shay LA, Lafata JE. Understanding patient perceptions of shared decision making. Patient Educ Couns 2014; 96(3): 295-301.[http://dx.doi.org/10.1016/j.pec.2014.07.017] [PMID: 25097150]
[68] Ford S, Schofield T, Hope T. What are the ingredients for a successful evidence-based patient choice consultation?: A qualitative study. Soc Sci Med 2003; 56(3): 589-602.[http://dx.doi.org/10.1016/S0277-9536(02)00056-4] [PMID: 12570976]
[69] Saba GW, Wong ST, Schillinger D, et al. Shared decision making and the experience of partnership in primary care. Ann Fam Med 2006; 4(1): 54-62.[http://dx.doi.org/10.1370/afm.393] [PMID: 16449397]
[70] Siminoff LA, Step MM. A communication model of shared decision making: Accounting for cancer treatment decisions. Health Psychol 2005; 24(4S)(Suppl.): S99-S105.[http://dx.doi.org/10.1037/0278-6133.24.4.S99] [PMID: 16045427]
[71] Thorne S, Oliffe JL, Stajduhar KI. Communicating shared decision-making: Cancer patient perspectives. Patient Educ Couns 2013; 90(3): 291-6.[http://dx.doi.org/10.1016/j.pec.2012.02.018] [PMID: 22464665]
[72] White MK, Keller V, Horrigan LA. Beyond informed consent: The shared decision making process. J Clin Outcomes Manag 2003; 10(6): 323-8.
[73] Zoffmann V, Harder I, Kirkevold M. A person-centered communication and reflection model: Sharing decision-making in chronic care. Qual Health Res 2008; 18(5): 670-85.[http://dx.doi.org/10.1177/1049732307311008] [PMID: 18223158]
[74] Charles C, Gafni A, Whelan T. Decision-making in the physician-patient encounter: Revisiting the shared treatment decision-making model. Soc Sci Med 1999; 49(5): 651-61.[http://dx.doi.org/10.1016/S0277-9536(99)00145-8] [PMID: 10452420]
[75] Müller-Engelmann M, Keller H, Donner-Banzhoff N, Krones T. Shared decision making in medicine: The influence of situational treatment factors. Patient Educ Couns 2011; 82(2): 240-6.[http://dx.doi.org/10.1016/j.pec.2010.04.028] [PMID: 20542403]
[76] LeBlanc A, Kenny DA, O’Connor AM, Légaré F. Decisional conflict in patients and their physicians: A dyadic approach to shared decision making. Med Decis Making 2009; 29(1): 61-8.[http://dx.doi.org/10.1177/0272989X08327067] [PMID: 19196706]
[77] Peek ME, Quinn MT, Gorawara-Bhat R, Odoms-Young A, Wilson SC, Chin MH. How is shared decision-making defined among African-Americans with diabetes? Patient Educ Couns 2008; 72(3): 450-8.[http://dx.doi.org/10.1016/j.pec.2008.05.018] [PMID: 18684581]
[78] Elwyn G, Frosch D, Thomson R, et al. Shared decision making: A model for clinical practice. J Gen Intern Med 2012; 27(10): 1361-7.[http://dx.doi.org/10.1007/s11606-012-2077-6] [PMID: 22618581]
[79] Schon DA. The reflective practitioner: How professionals think in action 1st ed. 1st ed.1984.
[80] Smith SK, Dixon A, Trevena L, Nutbeam D, McCaffery KJ. Exploring patient involvement in healthcare decision making across different education and functional health literacy groups. Soc Sci Med 2009; 69(12): 1805-12.[http://dx.doi.org/10.1016/j.socscimed.2009.09.056] [PMID: 19846245]

Endorsements



"Open access will revolutionize 21st century knowledge work and accelerate the diffusion of ideas and evidence that support just in time learning and the evolution of thinking in a number of disciplines."


Daniel Pesut
(Indiana University School of Nursing, USA)

"It is important that students and researchers from all over the world can have easy access to relevant, high-standard and timely scientific information. This is exactly what Open Access Journals provide and this is the reason why I support this endeavor."


Jacques Descotes
(Centre Antipoison-Centre de Pharmacovigilance, France)

"Publishing research articles is the key for future scientific progress. Open Access publishing is therefore of utmost importance for wider dissemination of information, and will help serving the best interest of the scientific community."


Patrice Talaga
(UCB S.A., Belgium)

"Open access journals are a novel concept in the medical literature. They offer accessible information to a wide variety of individuals, including physicians, medical students, clinical investigators, and the general public. They are an outstanding source of medical and scientific information."


Jeffrey M. Weinberg
(St. Luke's-Roosevelt Hospital Center, USA)

"Open access journals are extremely useful for graduate students, investigators and all other interested persons to read important scientific articles and subscribe scientific journals. Indeed, the research articles span a wide range of area and of high quality. This is specially a must for researchers belonging to institutions with limited library facility and funding to subscribe scientific journals."


Debomoy K. Lahiri
(Indiana University School of Medicine, USA)

"Open access journals represent a major break-through in publishing. They provide easy access to the latest research on a wide variety of issues. Relevant and timely articles are made available in a fraction of the time taken by more conventional publishers. Articles are of uniformly high quality and written by the world's leading authorities."


Robert Looney
(Naval Postgraduate School, USA)

"Open access journals have transformed the way scientific data is published and disseminated: particularly, whilst ensuring a high quality standard and transparency in the editorial process, they have increased the access to the scientific literature by those researchers that have limited library support or that are working on small budgets."


Richard Reithinger
(Westat, USA)

"Not only do open access journals greatly improve the access to high quality information for scientists in the developing world, it also provides extra exposure for our papers."


J. Ferwerda
(University of Oxford, UK)

"Open Access 'Chemistry' Journals allow the dissemination of knowledge at your finger tips without paying for the scientific content."


Sean L. Kitson
(Almac Sciences, Northern Ireland)

"In principle, all scientific journals should have open access, as should be science itself. Open access journals are very helpful for students, researchers and the general public including people from institutions which do not have library or cannot afford to subscribe scientific journals. The articles are high standard and cover a wide area."


Hubert Wolterbeek
(Delft University of Technology, The Netherlands)

"The widest possible diffusion of information is critical for the advancement of science. In this perspective, open access journals are instrumental in fostering researches and achievements."


Alessandro Laviano
(Sapienza - University of Rome, Italy)

"Open access journals are very useful for all scientists as they can have quick information in the different fields of science."


Philippe Hernigou
(Paris University, France)

"There are many scientists who can not afford the rather expensive subscriptions to scientific journals. Open access journals offer a good alternative for free access to good quality scientific information."


Fidel Toldrá
(Instituto de Agroquimica y Tecnologia de Alimentos, Spain)

"Open access journals have become a fundamental tool for students, researchers, patients and the general public. Many people from institutions which do not have library or cannot afford to subscribe scientific journals benefit of them on a daily basis. The articles are among the best and cover most scientific areas."


M. Bendandi
(University Clinic of Navarre, Spain)

"These journals provide researchers with a platform for rapid, open access scientific communication. The articles are of high quality and broad scope."


Peter Chiba
(University of Vienna, Austria)

"Open access journals are probably one of the most important contributions to promote and diffuse science worldwide."


Jaime Sampaio
(University of Trás-os-Montes e Alto Douro, Portugal)

"Open access journals make up a new and rather revolutionary way to scientific publication. This option opens several quite interesting possibilities to disseminate openly and freely new knowledge and even to facilitate interpersonal communication among scientists."


Eduardo A. Castro
(INIFTA, Argentina)

"Open access journals are freely available online throughout the world, for you to read, download, copy, distribute, and use. The articles published in the open access journals are high quality and cover a wide range of fields."


Kenji Hashimoto
(Chiba University, Japan)

"Open Access journals offer an innovative and efficient way of publication for academics and professionals in a wide range of disciplines. The papers published are of high quality after rigorous peer review and they are Indexed in: major international databases. I read Open Access journals to keep abreast of the recent development in my field of study."


Daniel Shek
(Chinese University of Hong Kong, Hong Kong)

"It is a modern trend for publishers to establish open access journals. Researchers, faculty members, and students will be greatly benefited by the new journals of Bentham Science Publishers Ltd. in this category."


Jih Ru Hwu
(National Central University, Taiwan)


Browse Contents



Webmaster Contact: info@benthamopen.net
Copyright © 2019 Bentham Open