Development of a Shared Decision-Making Program Theory: A Realist Synthesis Examining Contexts and Mechanisms to Engagement

Abstract

Purpose: Shared Decision-making (SDM) is a style of medical decision-making that focuses on balancing the relationship between patients, physicians, and other key players. SDM is purported to improve patient and system outcomes; however, the potential effectiveness is challenged in part due to gaps in the current literature between theory and implementation. With my team, I conducted a realist synthesis of SDM literature to identify “In which situations, how, why, and for whom does SDM between patients and health care providers contribute to improved patient-centered decisions?” Method: We conducted a seven step iterative process, including: preliminary theory development, establishment of a search strategy, selection and appraisal of literature, data extraction, identification of formal theories, analysis and synthesis of extracted results from literature, and formation of a revised program theory with the input of patients, physicians, nurse navigators, and policy makers from a stakeholder session Results: We developed a program theory comprised of eight complex, interrelated mechanisms, three contexts, and a single outcome of engagement in SDM. Conclusion: Our realist synthesis produced a program theory for SDM through the identification of mechanisms which shape the characteristics of when, how, and why SDM will, and will not, work. This research hypothesizes that by facilitating high engagement of SDM, medical consultations will lead to informed, patient-centered decisions.