An umbrella review of patient-reported shared decision-making instruments: Developing a contemporary model of the shared decision-making process

Objective: Shared decision making (SDM) can be conceptualized as observable communication behaviors that foster collaborative decision making. We aimed to develop a compendium of patient-reported SDM instruments and characterize the communication behaviors assessed by them. We then used the identified behaviors to develop a contemporary integrative model of the SDM process. Methods: PubMed, Embase, Cochrane Library, and CINAHL were systematically searched through July 2024. Published reviews of SDM instruments were eligible if they included instruments without context restrictions and were available as full text in English, supplemented by a primary search since the last review for potential instruments not included in reviews. Instruments were eligible if they were patient-reported and included at least one item assessing a SDM communication behavior. All items from the included instruments were extracted verbatim and directed content analysis was used to code for SDM communication behaviors. Results: Of 1049 records, 14 reviews underwent full-text assessment, and 9 were included (2007–2021), collectively identifying 98 unique instruments. Twenty-one patient-reported instruments met inclusion criteria, comprising 283 items. Nineteen instruments measured information exchange communication behaviors, including creating choice awareness (n = 8), sharing information and discussing options (n = 12), eliciting and integrating patient preferences (n = 19), and discussing choice enactment (n = 8). Eighteen instruments measured relationship building communication behaviors separately from information exchange, including partnership building (n = 17) and rapport building (n = 6). Sixteen spanned both informational and relational domains, and none contained at least one item measuring all six domains. Conclusions: This review provides a compendium of patient-reported SDM process instruments to support selection of measures aligned with specific conceptual, practice, and research needs. Drawing from the communication behaviors represented in existing instruments, we propose a contemporary integrative model of the SDM process. Practice implications: To comprehensively conceptualize and measure the SDM process, measurement instruments need to consider both information exchange and relationship building communication behaviors.