weighed across the options (Elwyn et al., 2000). An interprofessional approach to SDM requires that professionals share their knowledge and understand- ing of the options with the patient while recognising equipoise and the need for a decision. Step 2. This involves the ‘‘exchange of information’’ about the options relevant to the patient’s health condi- tion. The health professional(s) and the patient share information about the potential beneﬁts and harms of the options, using educational material, patient decision aids, and other evidence-based resources. Again, the dotted lines that run through the cells of the individuals indicate discussion among those involved, including the health profes- sionals, about the available options. Step 3. This requires ‘‘values clariﬁcation’’ by individuals involved in the decision-making process. While patient values are ideally the cornerstone of SDM, this model recognises that the values of all the actors may inﬂuence the decision. These actors, including health professionals, should understand the values that are at play, even when they do not share them. At the very least, future research and theoretical development should consider the impact of multiple sets of values on the IP-SDM process. Step 4. This underlines the need to consider the ‘‘feasibility of the options’’ during the decision- making process. We recognise that the availability of some healthcare options varies considerably across healthcare systems and nations, and that a given option may be unfeasible for reasons concerning time or resources. The local avail- ability of the required expertise is therefore not trivial to the decision. For that reason, it is important that the interprofessional team (which includes the patient) analyse the feasibility of the options before determining individual preferences. Step 5. This results in the actual decision. With help from different individuals, the patient identiﬁes his/her preferred option. Healthcare providers may also prefer an option and share their preference with the patient in the form of a recommendation. Ideally, the ﬁnal decision is agreed upon by all. At the very least, the decision must be endorsed by the healthcare provider, who can help the patient access the choice and arrange the steps necessary for its implementa- tion. In case of disagreement, the decision may be deferred. Step 6. This involves supporting the patient so the option s/ he chooses has a favourable impact on the health outcomes that s/he values most. Both implementa- tion ﬁdelity (the extent to which the option is implemented as planned) and health outcomes must be evaluated to further inform the decision- making process. Many healthcare decisions will need to be revisited by patients, their families and the interprofessional team, especially when the 2011 Informa UK, Ltd. INTERPROFESSIONALISM AND SHARED DECISION-MAKING 21 initial choice does not produce the desired health outcomes. The assumption that underlies this section of the model is that involving the patient in the decision-making process is essential for achieving patient-centered care and for reaching an informed decision that reﬂects the patient’s values. Shared decisions are reached when the actors achieve common understanding of the essential elements of the options through the decision-making process and when they recognise that various actors inﬂuence the decision. Healthcare system (meso and macro) levels Figure 3 is a schematic representation of the proposed IP- SDM model at the meso level (healthcare teams and organizations) and the macro level (health policies, social context, and professional organization). The diamond at the top of the pyramid represents the individual level process illustrated in Figure 2 and discussed above. The other sections of the pyramid capture either the elements or the individuals from the healthcare system that may inﬂuence the adoption of an interprofessional approach to SDM. The darkly shaded section in the middle represents healthcare professionals who may be involved in the SDM process (meso level). The darkly shaded section at the bottom lists elements of the global environment – resources, government policies, cultural values, professional organisations, and rules – that may similarly be involved (macro level). Finally, the two transition zones symbolise the manner in which health system elements and individuals inﬂuence SDM. Towards the top, the team inﬂuences the SDM process through the roles played its members. For this, the team must develop collaborative communication that is authentic, constructive, and open, so as to foster mutual trust and respect among team members as well as between the team and the patient. Interprofes- sional team members must also recognise that broader factors are likely to affect their ability to collaborate with the patient in decision-making. Patients decision aids may help foster this collaboration (O’Connor et al., 1998). At the bottom (macro level), we suggest that the global environ- ment inﬂuences how the team is organised and functions. This model assumes that an interprofessional approach to SDM within clinical encounters cannot occur indepen- dently of the inﬂuence of factors from the healthcare system levels. Indeed, the healthcare system elements at the base of the pyramid (the macro level) exert signiﬁcant inﬂuence. For example, within healthcare teams (meso level), an interprofessional approach to SDM is inﬂuenced by each member’s professional role, and each member’s professional role is in turn fostered or constrained by organizational routines (May et al., 2007a,b) and/or innovations within teams. Teams are also embedded within larger organizational and social contexts, which constitute their global environment (macro level). We suggest that even where a team shows strong interest in implementing an IP-SDM approach, the team is embedded