Interprofessionalism and shared decision-making in primary care: a stepwise approach towards a new model

France Légaré,Dawn Stacey,Sophie Pouliot,François-Pierre Gauvin,Sophie Desroches,Jennifer Kryworuchko,Sandy Dunn,Glyn Elwyn,Dominick Frosch,Marie-Pierre Gagnon,Margaret B Harrison,Pierre Pluye,Ian D Graham

doi:10.3109/13561820.2010.490502

Abstract

Most shared decision-making (SDM) models within healthcare have been limited to the patient–physician dyad. As a first step towards promoting an interprofessional approach to SDM in primary care, this article reports how an interprofessional and interdisciplinary group developed and achieved consensus on a new interprofessional SDM model. The key concepts within published reviews of SDM models and interprofessionalism were identified, analysed, and discussed by the group in order to reach consensus on the new interprofessional SDM (IP-SDM) model. The IP-SDM model comprises three levels: the individual (micro) level and two healthcare system (meso and macro) levels. At the individual level, the patient presents with a health condition that requires decision-making and follows a structured process to make an informed, value-based decision in concert with a team of healthcare professionals. The model acknowledges (at the meso level) the influence of individual team members' professional roles including the decision coach and organizational routines. At the macro level it acknowledges the influence of system level factors (i.e. health policies, professional organisations, and social context) on the meso and individual levels. Subsequently, the IP-SDM model will be validated with other stakeholders.

Highlights

Most shared decision-making (SDM) models to date have been limited to the patient–physician dyad
We argue that a model for an interprofessional approach to SDM could improve the quality of decision support provided to patients in team-based primary care practices: such a model would truly value patient-centered care
LEGARE ET AL. et al, 2005; Xyrichis & Ream, 2008) and identified 10 key concepts. We used these results to compile a list of 28 key concepts relevant to interprofessionalism or SDM for participants to use as building blocks for the consensusbuilding exercise

Summary

Introduction

Most shared decision-making (SDM) models to date have been limited to the patient–physician dyad. For that reason, they are not always relevant to the increasingly interprofessional nature of the delivery of care. A recent systematic review identified 161 definitions of SDM in medical encounters and summarised the key elements in an integrative model (Makoul & Clayman, 2006). Marshall et al (2005) stated that ‘‘in a world of multi-disciplinary care and substitution of medical inputs wherever appropriate, it would be timely for studies to test methods of enhancing patient involvement in decisions shared with other health-care providers’’ (p.31). A new conceptual SDM model that explores how to involve patients in the process by which healthcare decisions are made, not with a single healthcare provider but with a team, is needed

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Results

Discussion

Conclusion