Shared decision-making, the working alliance, and patient-centered care: A simultaneous concept analysis and review of the literature.

Abstract

To identify the conceptual similarities, differences, and interrelationships between shared decision-making (SDM), the working alliance, and patient-centered care (PCC) in primary care. This study is a simultaneous concept analysis based on the method of Walker and Avant (2005) and Haase et al. (1992). First, a systematic search was conducted for articles published between 2012 and 2022 to identify those describing definitions, antecedents, attributes, consequences, and empirical referents of any of the three concepts. Then, data was extracted and organized into a validity matrix for comparison. Shared decision-making is a procedural communicative process involving both providers and patients in making clinical decisions. The working alliance between the patient and provider serves as a relational model foundational to the patient-provider relationship. Patient-centered care is an approach or philosophy adopted by clinicians (dyadic PCC) or organizations (organizational PCC) that shapes how care is conceptualized and delivered. Collaboration, common ground, integration of patient preferences, and information exchange are integral to all three concepts but are emphasized to varying degrees. PCC can be applied unilaterally, while SDM and the working alliance are always relational. Overall, the working alliance establishes the context in which providers adopt a patient-centered approach and can practice SDM. Shared decision-making, the working alliance, and patient-centered care are distinct concepts but are intrinsically interrelated in both theory and practice. The working alliance can be described as a relational "setting" where PCC (an approach to care) can be applied and SDM (a conversational model) can be practiced. Practice implications This study contributes to enhancing the conceptual clarity of the three concepts in the primary care, which may facilitate better operationalization and subsequent care design.