Abstract
BackgroundA growing body of literature documents the efficacy of decision support interventions (DESI) in helping patients make informed clinical decisions. DESIs are frequently described as an adjunct to shared decision-making between a patient and healthcare provider, however little is known about the effects of DESIs on patients' interactional behaviors-whether or not they promote the involvement of patients in decisions.DiscussionShared decision-making requires not only a cognitive understanding of the medical problem and deliberation about the potential options to address it, but also a number of communicative behaviors that the patient and physician need to engage in to reach the goal of making a shared decision. Theoretical models of behavior can guide both the identification of constructs that will predict the performance or non-performance of specific behaviors relevant to shared decision-making, as well as inform the development of interventions to promote these specific behaviors. We describe how Fishbein's Integrative Model (IM) of behavior can be applied to the development and evaluation of DESIs. There are several ways in which the IM could be used in research on the behavioral effects of DESIs. An investigator could measure the effects of an intervention on the central constructs of the IM - attitudes, normative pressure, self-efficacy, and intentions related to communication behaviors relevant to shared decision-making. However, if one were interested in the determinants of these domains, formative qualitative research would be necessary to elicit the salient beliefs underlying each of the central constructs. Formative research can help identify potential targets for a theory-based intervention to maximize the likelihood that it will influence the behavior of interest or to develop a more fine-grained understanding of intervention effects.SummaryBehavioral theory can guide the development and evaluation of DESIs to increase the likelihood that these will prepare patients to play a more active role in the decision-making process. Self-reported behavioral measures can reduce the measurement burden for investigators and create a standardized method for examining and reporting the determinants of communication behaviors necessary for shared decision-making.
Highlights
A growing body of literature documents the efficacy of decision support interventions (DESI) in helping patients make informed clinical decisions
More than a decade of research on DESIs has clearly demonstrated that they have significant positive impacts on the cognitive dimensions of patient involvement in clinical decision-making [17]
Important questions remain in the cognitive realm [46], it is important that investigators begin to examine how DESIs can impact interactional behavior, both on the part of patients and physicians
Summary
A growing body of literature documents the efficacy of decision support interventions (DESI) in helping patients make informed clinical decisions. Over the last several decades, we have witnessed a redefinition of the role of patients in decision-making This new conceptualization of the role of patients in decision-making in healthcare settings is often termed 'shared decisionmaking' [1,2,3]. The key point for researchers interested in the development of interventions for facilitating shared decision-making is that many of these behaviors may be contextually new for patients. A critical component of any decision support intervention (DESI) is the degree to which it provides information about the decision in question, and the degree to which the intervention facilitates adoption of these new behaviors by patients.
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