Validating a conceptual model for an inter-professional approach to shared decision making: a mixed methods study.
OBJECTIVE
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.
Légaré
France
F
Research Center of the Centre Hospitalier Universitaire de Québec, Québec, Canada. france.legare@mfa.ulaval.ca
Stacey
Dawn
D
Gagnon
Susie
S
Dunn
Sandy
S
Pluye
Pierre
P
Frosch
Dominick
D
Kryworuchko
Jennifer
J
Elwyn
Glyn
G
Gagnon
Marie-Pierre
MP
Graham
Ian D
ID
D000328:Adult; D001291:Attitude of Health Personnel; D002170:Canada; D003657:Decision Making; D004059:Diffusion of Innovation; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D011795:Surveys and Questionnaires; D055815:Young Adult