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Table 2 Definition of concepts in the Revised Program Theory

From: Development of a program theory for shared decision-making: a realist synthesis

 FactorDefinition
Key MechanismsAnxietyThe level of worry or nervousness felt before or during the consultation. This can be specifically related to the decision process/diagnosis, or other outside influences.
Key MechanismsPerception of capacity to access external supportThe perception of the individuala in relation to their ability to obtain support outside of the consultation. This can include, but is not limited to: support groups, family and friends, colleagues, internet resources, and manuscripts.
Key MechanismsPerception of other party capacityThe perception held by one individual regarding the other’s ability to successfully meet the expectations of their role within the consultation. For example, the perception the patient has regarding the HCPs knowledge and experience for their disease.
Key MechanismsPerception of timeThe perception of how long it takes to implement SDM, and the amount of time available for the consultation. HCPs may perceive inadequate time allotted to implement SDM. This can include potential time pressures on the patient. This also incorporates the perception of time available to make a decision (e.g. perceived urgency of treatment).
Key MechanismsSelf-efficacyThe individual’s belief he/she is able to participate within the SDM process. For example, whether the HCP believes he/she can successfully exchange their knowledge and expertise to the patient, and whether the patient believes they can adhere to potential treatment options. This may also be influenced by whether a healthcare system has provided appropriate supports for patients and HCPs to successfully implement SDM.
Key MechanismsTrustThe level of trust and confidence that the individual feels for the other person. For patients, this also includes the trust for the HCP as a professional. For HCPs, it may include the trust for patient to adhere to the treatment or be forth-coming.
Key MechanismsWorld viewThe set of beliefs, customs, values, morals and/or understandings that the individual holds about the medical process that may align with, or clash against, biomedical definitions of health care. This may incorporate aspects such as religion and culture.
Key MechanismsRecognition of decisionWhether the HCP or patient consciously acknowledges that a decision-choice exists.
ContextDifficulty of decision to be madeThe perception the individual holds on the how complex the decision needing to be made is. This can be significantly affected by values and preferences, as well as experience.
Key MechanismsPre-existing relationshipThe existence, duration, and quality, of a professional relationship between the patient and the HCP(s) prior to the consultation. This may also include assumptions that may be made based on the nature of the pre-existing relationship.
ContextSystem supportThe presence of policy, training, financial, decision tools, and managerial support for the implementation and use of SDM within consultation. This can extend to the extended time allotment for consultation and providing decision tools, among other supports.
OutcomeEngagement in SDMThe degree to which the individuals, together and individually, are able to cohesively engage within the SDM process given the interaction of key mechanisms.
  1. This table presents the contexts, mechanisms, and outcomes that are incorporated into the revised program theory, and definitions of each concept. These definitions represent what was found in our synthesis; future research may highlight the need for modification aindividual is operationally defined as either the health care professional and/or the patient