Shared Decision Making (SDM) is a decision making process that emphasizes a balanced relationship between patients and physicians, and is believed to improve patient outcomes while decreasing treatment variation. SDM involves discussion of treatment options and preferences, with the aim of mutual consensus between patient and practitioner regarding treatment decisions. Generally, in SDM, patient autonomy is acknowledged, and the use of decision-making aids (such as paper or electronic, numerical, or visual explanations) is encouraged.
Despite multiple models of SDM in the literature, a standardized definition of SDM does not exist, and tests of its efficacy on patient, provider, and system outcomes are limited. Although SDM has been endorsed by the Ministry of Health (MOH) in Saskatchewan, Canada, widespread implementation of SDM has not occurred in the province. To help bridge the gap between provincial support and implementation, this study aims to develop an initial program theory of SDM using realist methodology by assessing: In which situations, how, why and for whom does SDM between patients and physicians contribute to improved quality of care?
To assess this question, we will conduct three phases of research; a comprehensive realist-based literature search to improve the evidence base for SDM implementation and effectiveness, development of an initial program theory for SDM through consultation with stakeholders, and testing of the initial program theory within complex clinical situations (the third phase not being considered within this abstract).
Using a realist methodology to guide our research, we conducted a purposive search of the SDM literature, which rendered 198 references. These sources were screened by two members of our research team to exclude out-of-scope articles (i.e., end-of-life, pediatrics, decision aids, and those not focused on SDM). A total of 85 articles were used to extract propositions to form the basis of our program theory.
During the data extraction phase, we identified sources according to type of data (theoretical versus empirical) and geographical context. We then constructed if-then propositions from the data. The resulting 294 propositions were then organized by study focus (practitioner, patients, or both) and grouped using thematic analysis. For example, we found several themes in the patient group such as knowledge, disease severity, socio-economic status, and gender.
Our team collectively consolidated these propositions into Context-Mechanism-Outcome Configurations (CMOCs) and synthesized identified mechanisms into the program theory to provide insight into how and why SDM interventions work to improve quality outcomes in medical situations. We intend to consult stakeholder groups and refine the program theory to reflect stakeholder input. Future steps include empirically testing this program theory in an array of contexts.
The finished program theory is intended to be implemented into the local health region to facilitate optimal decision making for patients in a variety of health contexts.
Please select one of the following:: Combining Realist Evaluation and Synthesis , Please select a maximum of two themes from the following list:: Exploring 'Mechanisms' , Please select a maximum of two themes from the following list:: Realist Methodology in Und
