• Open Access

Validating a conceptual model for an inter-professional approach to shared decision making: a mixed methods study

Authors

  • France Légaré MD PhD,

    Corresponding author
    1. Tier 2 Canada Research Chair in Implementation of Shared Decision Making in Primary Care, Research Center of the Centre Hospitalier Universitaire de Québec, Québec, Canada and Professor, Department of Family and Emergency Medicine, Université Laval, Québec, Canada
      Dr France Légaré, Research Center, Hôpital Saint-François d'Assise, Centre Hospitalier Universitaire de Québec, 10, de L'Espinay, Local D6-735, Québec (Québec) G1L 3L5, Canada. E-mail: france.legare@mfa.ulaval.ca
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  • Dawn Stacey RN MScN PhD,

    1. Clinical investigator, Ottawa Hospital Research Institute, Ottawa, Canada and Assistant Professor, Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Canada
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  • Susie Gagnon MA,

    1. Research Assistant, Knowledge Transfer and Health Technology Assessment, Research Center of the Centre Hospitalier Universitaire de Québec, Québec, Canada
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  • Sandy Dunn RN PhD(c),

    1. Student, Ottawa Hospital Research Institute, Ottawa, Canada and Student, Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Canada
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  • Pierre Pluye MD PhD,

    1. Assistant Professor, Department of Family Medicine, McGill University, Montréal, Canada
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  • Dominick Frosch PhD,

    1. Assistant Professor, Department of Medicine, University of California, Los Angeles, CA, USA
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  • Jennifer Kryworuchko RN PhD(c) CNCC(c),

    1. Assistant Professor, College of Nursing, University of Saskatchewan, Saskatchewan, Canada
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  • Glyn Elwyn MD PhD,

    1. Director of Research, Department of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK
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  • Marie-Pierre Gagnon PhD,

    1. Assistant Professor, Faculty of Nursing Sciences, Laval University, Québec, Canada and Researcher, Knowledge Transfer and Health Technology Assessment, Research Center of the Centre Hospitalier Universitaire de Québec, Québec, Canada
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  • Ian D. Graham PhD

    1. Assistant Professor, Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Canada and Vice-President of Knowledge Translation, Canadian Institutes of Health Research, Knowledge Translation Portfolio, Ottawa, Canada
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Dr France Légaré, Research Center, Hôpital Saint-François d'Assise, Centre Hospitalier Universitaire de Québec, 10, de L'Espinay, Local D6-735, Québec (Québec) G1L 3L5, Canada. E-mail: france.legare@mfa.ulaval.ca

Abstract

Rationale, aims and objectives  Following increased interest in having inter-professional (IP) health care teams engage patients in decision making, we developed a conceptual model for an IP approach to shared decision making (SDM) in primary care. We assessed the validity of the model with stakeholders in Canada.

Methods  In 15 individual interviews and 7 group interviews with 79 stakeholders, we asked them to: (1) propose changes to the IP-SDM model; (2) identify barriers and facilitators to the model's implementation in clinical practice; and (3) assess the model using a theory appraisal questionnaire. We performed a thematic analysis of the transcripts and a descriptive analysis of the questionnaires.

Results  Stakeholders suggested placing the patient at its centre; extending the concept of family to include significant others; clarifying outcomes; highlighting the concept of time; merging the micro, meso and macro levels in one figure; and recognizing the influence of the environment and emotions. The most common barriers identified were time constraints, insufficient resources and an imbalance of power among health professionals. The most common facilitators were education and training in inter-professionalism and SDM, motivation to achieve an IP approach to SDM, and mutual knowledge and understanding of disciplinary roles. Most stakeholders considered that the concepts and relationships between the concepts were clear and rated the model as logical, testable, having clear schematic representation, and being relevant to inter-professional collaboration, SDM and primary care.

Conclusions  Stakeholders validated the new IP-SDM model for primary care settings and proposed few modifications. Future research should assess if the model helps implement SDM in IP clinical practice.

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