22 F. LE´GARE´ ET AL. Figure 3. IP-SDM model – healthcare system (meso and macro) levels representing the global inﬂuences in which the individual level is embedded. in a larger system and is likely to need government policies and healthcare organization managers to share its goal. If the goal is not shared by components of the larger system, widespread dissemination and implementation across all primary healthcare settings is unlikely. With agreement ranging from 80–100%, results from the theory appraisal questionnaire show that workshop participants reached near consensus on this model. DISCUSSION To the best of our knowledge, this study is among the ﬁrst to propose a new integrated model for an interprofessional approach to SDM in clinical primary care. The model was developed by an interprofessional, interdisciplinary and international team using a rigorous methodology and a stepwise approach over a one-year period. The model is comprised of three levels: the individual (micro) level and two healthcare system (meso and macro) levels. The individual level represents the pathway through which a patient with a health condition having two or more options can engage in a decision-making process with two or more health professionals. The model acknowledges the inﬂuence of meso and macro level healthcare system factors on the clinical practice decision-making encounter at the indivi- dual level. This model is unique in that it proposes to innovate the process of decision-making in primary care clinical practice, education and research in several ways. The model has the potential to improve traditional decision-making processes and working practices currently exercised in many industrialised healthcare systems. A review of 38 studies of health professionals’ perceptions of barriers and facilitators to implementing SDM in clinical practice reported that the vast majority of participants (n ¼ 3231) were physicians (89%). This suggests the lack of an interprofessional perspective on SDM (Le´gare´ et al., 2008b). Interestingly, the most frequently reported barrier was time constraint (22/38). This ﬁnding reinforces the need to foster a more coordinated interprofessional effort for implementing SDM in clinical practice. We believe that the IP-SDM model proposed here can address some of the barriers reported, help various health professionals envision a common goal (namely supporting and engaging patients in decision-making), and enhance the contribution of different health professions to patient decision-making. Without a common conceptual understanding between professionals, policy-makers, decision-makers, the public, and other stakeholders, it can be difﬁcult to communicate effectively and compare experiences and expectations in healthcare systems across jurisdictions (Adcock, 2005; Sartori, 1970). The model has the potential to address the confusion that can give rise to conﬂicting expectations among actors and clarify the elements that training programs for an interprofessional approach to SDM should include. The model stresses the importance of facilitating communication between individuals involved throughout the decision-making process so that they share knowledge and arrive at a common understanding of the issues at stake. This goal is congruent with a model of interprofes- sional collaboration that emphasises the necessity for healthcare professionals to share their knowledge and understanding in order to develop a collaborative relation- ship that exceeds the implicit limits of each profession (D’Amour et al., 2005). In an interprofessional approach, information exchange does not only occur among health- care professionals, the patient, and his/her family members, but also among different healthcare professionals. In order to achieve fruitful communication among professionals, the Journal of Interprofessional Care