Shared Decision-Making Theories, Conceptual Models, and Frameworks Within Oral Healthcare: A Theory Analysis.

Abstract

Objective: To appraise the quality of theories, conceptual models, and theoretical frameworks about SDM for oral healthcare practices.

Background: Shared decision-making (SDM) is crucial to person-centred care. Yet little is known about how (and if) patient engagement in SDM is conceptualised in oral healthcare.

Methods: We conducted a theory analysis of theories, conceptual models, and frameworks. We searched Medline, Scopus, and CINAHL. Eligible theories/conceptual models/frameworks had to specifically focus on SDM in oral healthcare. Eligible papers were analysed using Walker and Avant's theory analysis steps and mapped onto the 8 core elements of SDM.

Main findings: Of 195 citations, two conceptual models specific to oral healthcare were identified. The SDM System on Dental Restorations (SDMS-DR; South Korea) focuses on decisions between dentists and patients about restorative treatment. The Four + one Habits Model for dental visits (4 + 1 HB; Norway) is an approach for SDM across oral healthcare decisions, more broadly. Both conceptual models focus on the patient-professional encounter and met 4 (SDMS-DR) and 6 (4 + 1HB) of the 8 core elements of SDM. The SDMS-DR provided no reference to the patients' expertise. The 4 + 1HB presented SDM as a standardised linear process rather than a dynamic process. Neither has been empirically tested, and they do not acknowledge the broader healthcare system within which the encounters take place.

Conclusion: We identified two conceptual models that incorporated some elements of SDM for oral healthcare. Neither was evaluated, and both focus exclusively on the patient-oral healthcare professional encounter, without consideration of intersectional, multidisciplinary healthcare services.