What value structure underlies shared decision making? A qualitative synthesis of models of shared decision making

Patient Education and Counseling, vol. 124, pp. 108284

Abstract

OBJECTIVE: To construct the underlying value structure of shared decision making (SDM) models. METHOD: We included previously identified SDM models (n = 40) and 15 additional ones. Using a thematic analysis, we coded the data using Schwartz's value theory to define values in SDM and to investigate value relations. RESULTS: We identified and defined eight values and developed three themes based on their relations: shared control, a safe and supportive environment, and decisions tailored to patients. We constructed a value structure based on the value relations and themes: the interplay of healthcare professionals' (HCPs) and patients' skills [Achievement], support for a patient [Benevolence], and a good relationship between HCP and patient [Security] all facilitate patients' autonomy [Self-Direction]. These values enable a more balanced relationship between HCP and patient and tailored decision making [Universalism]. CONCLUSION: SDM can be realized by an interplay of values. The values Benevolence and Security deserve more explicit attention, and may especially increase vulnerable patients' Self-Direction. PRACTICE IMPLICATIONS: This value structure enables a comparison of values underlying SDM with those of specific populations, facilitating the incorporation of patients' values into treatment decision making. It may also inform the development of SDM measures, interventions, education programs, and HCPs when practicing.

Authors 8

1. Roukayya Oueslati corresponding Aachen Department of Ethics and Law of Health Care

   Leiden University Medical Center · The Hague University of Applied Sciences

   Affiliation as printed

   Department of Ethics and Law of Health Care, Leiden University Medical Center, Leiden, the Netherlands; Department of Nursing and Research Group Oncological Care, The Hague University of Applied Sciences, The Hague, the Netherlands; Research Group Relational Care, The Hague University of Applied Sciences, The Hague, the Netherlands. Electronic address: r.oueslati@hhs.nl

   Department of Ethics and Law of Health Care, Leiden University Medical Center, Leiden, the Netherlands

   Department of Nursing and Research Group Oncological Care, The Hague University of Applied Sciences, The Hague, the Netherlands

   Research Group Relational Care, The Hague University of Applied Sciences, The Hague, the Netherlands

2. Anke J. Woudstra Aachen Medical Decision Making Department of Biomedical Data Sciences

   Leiden University Medical Center

   Affiliation as printed

   Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands

3. Rima Alkirawan Aachen Department of Ethics and Law of Health Care

   Leiden University Medical Center

   Affiliation as printed

   Department of Ethics and Law of Health Care, Leiden University Medical Center, Leiden, the Netherlands

4. Ria Reis Aachen Department of Public Health and Primary Care

   University of Cape Town · Leiden University Medical Center · Amsterdam Institute for Global Health and Development

   Affiliation as printed

   Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands; Amsterdam Institute of Global Health and Development, Amsterdam, the Netherlands; Children's Institute, University of Cape Town, Cape Town, South Africa

   Amsterdam institute of Global Health and Development, Amsterdam, the Netherlands

   Children's Institute, University of Cape Town, South Africa

   Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands

5. Yvonne van Zaalen

   The Hague University of Applied Sciences

   Affiliation as printed

   Research Group Relational Care, The Hague University of Applied Sciences, The Hague, the Netherlands

6. Meralda T. Slager

   Avans University of Applied Sciences

   Affiliation as printed

   Centre of Expertise Perspective in Health, Avans University of Applied Sciences, Breda, the Netherlands

   Centre of Expertise Perspective in Health, Avans University of Applied Sciences, the Netherlands

7. Anne Margarethe Stiggelbout Aachen Medical Decision Making Department of Biomedical Data Sciences

   Leiden University Medical Center · Erasmus University Rotterdam

   Affiliation as printed

   Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands; Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands

   Erasmus School of Health Policy and Management, Erasmus University Rotterdam, the Netherlands

   Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands

8. Dorothea Petra Touwen Aachen Department of Ethics and Law of Health Care

   Leiden University Medical Center

   Affiliation as printed

   Department of Ethics and Law of Health Care, Leiden University Medical Center, Leiden, the Netherlands