Towards A Comprehensive Framework For Shared Decision-Making: Defining The Process And Examining The Decision-Making Preferences Of Millennial Women

University of Minnesota Ph.D. dissertation. April 2020. Major: Health Services Research, Policy and Administration. Advisors: Donna McAlpine, Mary Butler. 1 computer file (PDF); ix, 210 pages.This research aimed to conduct a systematic literature review to synthesize and evaluate models of shared decision-making (SDM) and identify common: goals and objectives of SDM, components of SDM and how these are operationalized, and responsibilities assigned to patients and clinicians for participating in SDM. This research also aimed to conduct qualitative interviews with millennial women residing in Minnesota to examine the role of clinical severity and time in the formation of health care decision-making preferences of millennial women. The interviews used card sort exercise to examine decision-making preferences for three scenarios: painful periods, polycystic ovary syndrome (PCOS), and recurring ovarian cysts. The review findings outline the minimum necessary process steps to conduct SDM. I found that six SDM process components were common across models. These six components were: acknowledging that there is a decision to be made and there are options; patient preferences, values, or goals; information delivery/exchange, deliberation; making a decision; and post-decision evaluation and follow-up. Based on the available evidence, both the patient and the clinician have the responsibility of implementing two components: patient values, preferences, and goals and information delivery/exchange. Evidence was minimal to insufficient to for SDM goals and objectives and SDM model efficacy. The interview findings suggest that millennial women prefer a more active approach to health care decision-making for some clinician situations. During the interviews, participants preferred a more active form of decision-making for painful periods, but preferred SDM for PCOS and recurring ovarian cysts. For more uncertain and severe situations, participants expressed a willingness to give more power to clinicians due to their training and expertise, but were rarely willing to cede all decision-making power. This is a large shift from the traditional medical model and will most likely require investments in training and support for clinicians. While participants acknowledged the value of sufficient time with clinicians, there was not consensus regarding the role of time in decision-making preferences