• L Aubree Shay and Jennifer Elston Lafata.
• Center for Health Promotions and Research, University of Texas School of Public Health, San Antonio, USA. Electronic address: Laura.Aubree.Shay@uth.tmc.edu.
• Patient Educ Couns. 2014 Sep 1; 96 (3): 295-301.

ObjectiveThis study aims to develop a conceptual model of patient-defined SDM, and understand what leads patients to label a specific, decision-making process as shared.MethodsQualitative interviews were conducted with 23 primary care patients following a recent appointment. Patients were asked about the meaning of SDM and about specific decisions that they labeled as shared. Interviews were coded using qualitative content analysis.ResultsPatients' conceptual definition of SDM included four components of an interactive exchange prior to making the decision: both doctor and patient share information, both are open-minded and respectful, patient self-advocacy, and a personalized physician recommendation. Additionally, a long-term trusting relationship helps foster SDM. In contrast, when asked about a specific decision labeled as shared, patients described a range of interactions with the only commonality being that the two parties came to a mutually agreed-upon decision.ConclusionThere is no one-size-fits all process that leads patients to label a decision as shared. Rather, the outcome of "agreement" may be more important than the actual decision-making process for patients to label a decision as shared.Practice ImplicationsStudies are needed to better understand how longitudinal communication between patient and physicians and patient self-advocacy behaviors affect patient perceptions of SDM.Published by Elsevier Ireland Ltd.

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