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199 A Theory analysis of shared decision-making theories, conceptual models, and theoretical frameworks within dental healthcare
  1. Jessica Persson Kylén1,2,
  2. Inger Wårdh3,4,5,
  3. Dawn Stacey6,7,
  4. Krystina B Lewis6,7
  1. 1Department of Health Sciences, University West, 461 86 Trollhättan, Sweden
  2. 2Centre for Gerodontology, Public Dental Service, Region Västra Götaland, 402 33 Gothenburg, Sweden
  3. 3Department of Health Sciences, Karlstad University, 651 88 Karlstad, Sweden
  4. 4Department of Dental Medicine, Karolinska Institute, 141 04 Huddinge, Sweden
  5. 5Academic Centre for Geriatric Dentistry, 112 19 Stockholm, Sweden
  6. 6Faculty of Health Sciences, University of Ottawa, Canada
  7. 7Centre for Implementation Research, Ottawa Hospital Research Institute, Canada

Abstract

Introduction Oral health is critical for general health and quality of life [1–3]. Although there is emphasis on person-centred care in dental healthcare [4], little is known about how patient involvement in decision making is conceptualized in this context.

Objective To identify and conduct a theory analysis of theories, conceptual models, or theoretical frameworks (TCMTF) about shared decision making (SDM) in dental healthcare.

Methods We used Walker & Avant’s six-step theory analysis approach [5] to analyze TCMTF using a systematic search in three databases (MEDLINE, Scopus and CINAHL).

Results Of 195 citations identified, three conceptual models met eligibility criteria from Norway [6], South Korea [7], and United Kingdom [8]. Authors were mainly from the dental healthcare field, with involvement from psychology and sociology. No model was coproduced with patients. Two conceptual models [6,8] broadly approached decision-making inclusive of all dental healthcare encounters, while one was limited to decisions between dentists and patients regarding restorative treatment [7]. All conceptual models were parsimonious and schematically represented. None was empirically tested. All models focused at the level of the patient-professional encounter; none considered the organizational or system levels.

Discussion Current TCMTFs within dental healthcare approach patient involvement in decision- making using a linear, non-iterative approach. This is problematic as SDM is conceptualized as dynamic [9, 10]. Also, many decisions within dental healthcare cross into other disciplines, given poor oral health’s multifactorial origins, which often occur alongside other non-communicable diseases [11]. However, no model considered decision-making outside of dental healthcare encounters within or across other health care organizations.

Conclusion TCMTF about SDM in dental healthcare currently focus narrowly on dental healthcare without attention to organizational or system-wide influences. None were coproduced with patients. There is a research gap regarding the development of TCMTF for SDM within dental healthcare and their application in dental healthcare practices.

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