title: Collaborative deliberation: a model for patient care.
abstract: OBJECTIVE
  Existing theoretical work in decision making and behavior change has focused on how individuals arrive at decisions or form intentions. Less attention has been given to theorizing the requirements that might be necessary for individuals to work collaboratively to address difficult decisions, consider new alternatives, or change behaviors. The goal of this work was to develop, as a forerunner to a middle range theory, a conceptual model that considers the process of supporting patients to consider alternative health care options, in collaboration with clinicians, and others.
  
  
  METHODS
  Theory building among researchers with experience and expertise in clinician-patient communication, using an iterative cycle of discussions.
  
  
  RESULTS
  We developed a model composed of five inter-related propositions that serve as a foundation for clinical communication processes that honor the ethical principles of respecting individual agency, autonomy, and an empathic approach to practice. We named the model 'collaborative deliberation.' The propositions describe: (1) constructive interpersonal engagement, (2) recognition of alternative actions, (3) comparative learning, (4) preference construction and elicitation, and (5) preference integration.
  
  
  CONCLUSIONS
  We believe the model underpins multiple suggested approaches to clinical practice that take the form of patient centered care, motivational interviewing, goal setting, action planning, and shared decision making.
authors.affiliation: The Dartmouth Center for Health Care Delivery Science, Dartmouth College, USA. Electronic address: glynelwyn@gmail.com.
authors.forename: Glyn
authors.initials: G
authors.lastname: Elwyn
authors.affiliation: Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, UK.
authors.forename: Amy
authors.initials: A
authors.lastname: Lloyd
authors.affiliation: Faculty of Health Sciences, University of Southampton, UK.
authors.forename: Carl
authors.initials: C
authors.lastname: May
authors.affiliation: School Caphri, Department of Family Medicine, Maastricht University, The Netherlands.
authors.forename: Trudy
authors.initials: T
authors.lastname: van der Weijden
authors.affiliation: Department of Medical Decision Making, Leiden University, The Netherlands.
authors.forename: Anne
authors.initials: A
authors.lastname: Stiggelbout
authors.affiliation: Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, UK.
authors.forename: Adrian
authors.initials: A
authors.lastname: Edwards
authors.affiliation: Gordon and Betty Moore Foundation, USA; Department of Medicine, The University of California, Los Angeles, USA; Palo Alto Medical Foundation Research Institute, USA.
authors.forename: Dominick L
authors.initials: DL
authors.lastname: Frosch
authors.affiliation: Institute of Health & Society, Newcastle University, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Rapley
authors.affiliation: The Dartmouth Center for Health Care Delivery Science, Dartmouth College, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Barr
authors.affiliation: The Dartmouth Center for Health Care Delivery Science, Dartmouth College, USA.
authors.forename: Thom
authors.initials: T
authors.lastname: Walsh
authors.affiliation: The Dartmouth Center for Health Care Delivery Science, Dartmouth College, USA.
authors.forename: Stuart W
authors.initials: SW
authors.lastname: Grande
authors.affiliation: Health Care Delivery Research Program, Mayo Clinic Center for the Science of Health Care Delivery, Mayo Clinic, USA.
authors.forename: Victor
authors.initials: V
authors.lastname: Montori
authors.affiliation: Center for Communication and Disparities Research, Department of Family Medicine, University of Rochester, USA.
authors.forename: Ronald
authors.initials: R
authors.lastname: Epstein
mesh_terms: D000328:Adult; D003142:Communication; D003299:Cooperative Behavior; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062405:Motivational Interviewing; D005791:Patient Care / Q000379:methods*; D010358:Patient Participation / Q000523:psychology*; D018802:Patient-Centered Care / Q000379:methods; D010817:Physician-Patient Relations
keywords: Behavior change; Motivational interviewing; Patient centered care; Patient–clinician communication; Shared decision making