1. Aim To synthesize the best available evidence on shared decision-making (SDM) resulting in the development of a comprehensive model to be used as a guide for practice, policy, research, and educational initiatives. Background References Shared decision-making is a process where there is a sharing of information between a provider and patient and where this collaborative sharing results in a shared treatment decision leading to better patient health outcomes. 1,2 The literature on SDM from academicians, providers, and researchers is expansive illustrating its complexity. These works deal with the isolated components of this complex process that are portrayed individually creating snapshots each taking place in isolation. A comprehensive understanding is needed to assist in the development of practice, policy, and research initiatives as well as curricula for professional development towards SDM and improved patient-centered health outcomes. 1. Hain DJ, Sandy D. Partners in care: Patient empowerment through shared decision-making. Nephrology Nursing Journal 2013;40(2):153-7. 2. Salzburg Global Seminar. Salzburg statement on shared decision making [Internet]. 2011 [Cited July 24, 2015]. Available from: http://e-patients.net/u/2011/03/Salzburg- Statement.pdf 3. Whittemore R, Knafl K. The integrative review: Updated methodology. Journal of Advanced Nursing. 2005;52(5):546-53. See supplemental page for additional references. Methods Results Design. An integrative review using a framework adapted from Whittemore and Knafl 3 to identify, analyze, and synthesize the best available literature. Inclusion criteria. Addressed the process of SDM between an adult patient and provider—the dyad. Exclusion criteria. Addressed intervention strategies, e.g., education intervention, testing of decision aids. Psychiatric/mental health setting. Search methods. A comprehensive search for quantitative, qualitative, and theoretical papers from 1970 through October 2014 of the following electronic database: PubMed, CINAHL, the Cochrane Central Register of Controlled Trials (CENTRAL), and PsycINFO. Quality appraisal. Articles meeting the inclusion criteria were critically appraised using tools from the Joanne Briggs Institute. Data abstraction/Synthesis. Data were extracted and systematically analyzed using an inductive content analysis process to create categories and abstractions which were then grouped under higher order headings. The synthesis process involved creating categories that describes all of the aspects of the SDM process leading to a new representation of facts in the form of a model for SDM. Discussion The patient-provider relationship is a partnership where both parties are active, engaged, and collaborating. Interpersonal communication between the provider and patient takes place during the healthcare encounter. Intrapersonal communication occurs as reflection within the individual provider and patient, adding depth to the communication process. Strategic questioning and listening is used by the provider to facilitate a patient’s insight into the presiding issue and create conversations that explore options, leading towards SDM and action. Reflection also continues after the interaction as providers and patients reflect on how to act on the shared decision. Flexibility occurs as providers and patients work together, alternating who takes the lead, while seeking to find a patient’s comfort level about the assumed role in SDM. Providers will assume a diverse set of roles beyond coordinator and caregiver, such as educator and advocate. Similarly, the patient role is diverse, as patients are not only the recipients of care but partners in their care. Conclusion This integrative review presents a comprehensive and flexible model for SDM in which providers and patients work collaboratively in partnerships towards a shared decision. The model for SDM incorporates a structure and a process in which SDM takes place as a moment in time with implications for the shared decision over time. This flexible model facilitates the ability to strive for balance whether that balance is being sought for practice, policy, research, or education and has the potential to demonstrate improved patient outcomes. Evidence of improved patient outcomes will assist in the attainment of funding needed for the development and implementation of SDM initiatives as well as ensure the development of public policy that supports patient involvement in decision-making. Forty-five papers published between 1997 and 2014 were included in this review: 15 quantitative, 18 qualitative, and 12 conceptual. Data synthesis generated three themes each containing sub-themes that depict the process of SDM. Communication and relationship building o Individual characteristics (n = 17) o Relationship building-–trust and respect (n = 8) o Information exchange—communication (n = 21) o Context (n = 11) Working towards a shared decision o Assessment (n = 11) o Finding balance (n = 10) o Teaching-learning (n = 12) o The decision point (n = 4) Action o Taking action on the decision (n = 4) o Returning to the provider to re-evaluate the decision (n = 5) A model for SDM offering a representation of these themes is presented. This model provides a visual representation of the SDM process providing visual cues for practice, policy, research, and education. Shared Decision-Making for Research, Practice, and Education: Shared Decision-Making for Research, Practice, and Education: An Integrative Review Jason T. Slyer DNP, RN, FNP-BC, FNAP; Marie Truglio-Londrigan, PhD, RN, FNYAM Pace University, New York, NY Table 1. Basic search term strategies used across all databases Patient context search: Shared decision making AND Patient or patients or client or clients AND Experience or experiences or perspective or perspectives or satisfaction or preference or preferences or competent or competency or competencies or demographics or diagnosis or outcome or outcomes or literacy or culture or education Provider context search: Shared decision making AND Physician or physicians or doctor or doctors or clinician or clinician or provider or providers or nurse or nurses AND Experience or experiences or perspective or perspectives or satisfaction or preference or preferences or competent or competency or competencies or demographics or diagnosis or outcome or outcomes or literacy or culture or education Environment context search: Shared decision making ANDEnvironment or “environmental culture” or organization or “organizational culture” or policy or “health service culture” or context or commitment or consistency or continuity or time or economics or “financial resources” or resources Figure 1. PRISMA flow diagram of the article selection process. Figure 2. A model for shared decision-making in clinical practice, research, and education.