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

Roukayya Oueslati; Anke J Woudstra; Rima Alkirawan; Ria Reis; Yvonne van Zaalen; Meralda T Slager; Anne M Stiggelbout; Dorothea P Touwen

doi:10.1016/j.pec.2024.108284

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

Patient Educ Couns. 2024 Mar 30:124:108284. doi: 10.1016/j.pec.2024.108284. Online ahead of print.

Authors

Roukayya Oueslati¹, Anke J Woudstra², Rima Alkirawan³, Ria Reis⁴, Yvonne van Zaalen⁵, Meralda T Slager⁶, Anne M Stiggelbout⁷, Dorothea P Touwen³

Affiliations

¹ 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.
² Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.
³ Department of Ethics and Law of Health Care, Leiden University Medical Center, Leiden, the Netherlands.
⁴ 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.
⁵ Research Group Relational Care, The Hague University of Applied Sciences, The Hague, the Netherlands.
⁶ Centre of Expertise Perspective in Health, Avans University of Applied Sciences, Breda, the Netherlands.
⁷ 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.

PMID: 38583353
DOI: 10.1016/j.pec.2024.108284

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.

Keywords: Normativity; Qualitative synthesis; Scoping review; Shared decision making; Thematic analysis; Values; Vulnerable populations.

Publication types

Review