Journal of Interprofessional Care, 2011, 25: 18–25 2011 Informa UK, Ltd. ISSN 1356-1820 print/1469-9567 online DOI: 10.3109/13561820.2010.490502 Interprofessionalism and shared decision-making in primary care: a stepwise approach towards a new model France Le´ gare´ 1,2*, Dawn Stacey3,4,5, Sophie Pouliot1, François-Pierre Gauvin1, Sophie Desroches1, 4 4 6 7 1 Jennifer Kryworuchko , Sandy Dunn , Glyn Elwyn , Dominick Frosch , Marie-Pierre Gagnon , Margaret B. Harrison 5 , Pierre Pluye8, and Ian D. Graham3,4,5,9 1Research Center of the Centre Hospitalier Universitaire de Que´bec, Que´bec, Canada, 2Department of Family and Emergency Medicine, Universite´ Laval, Que´bec, Canada, 3Ottawa Hospital Research Institute, Ottawa, Canada, 4Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Canada, 5Faculty of Health Sciences, School of Nursing, Queen’s University, Kingston, Canada, 6Department of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK, 7Department of Medicine, University of California, Los Angeles, USA, 8Department of Family Medicine, McGill University, Montre´al, Canada, and 9Canadian Institutes of Health Research, Knowledge Translation Portfolio, Ottawa, Canada Most shared decision-making (SDM) models within healthcare have been limited to the patientphysician dyad. As a ﬁrst step towards promoting an interprofessional approach to SDM in primary care, this article reports how an interprofessional and interdisciplinary group developed and achieved consensus on a new interprofessional SDM model. The key concepts within published reviews of SDM models and interprofessionalism were identiﬁed, analysed, and discussed by the group in order to reach consensus on the new interprofessional SDM (IP-SDM) model. The IP-SDM model comprises three levels: the individual (micro) level and two healthcare system (meso and macro) levels. At the individual level, the patient presents with a health condition that requires decision-making and follows a structured process to make an informed, value-based decision in concert with a team of healthcare professionals. The model acknowl- edges (at the meso level) the inﬂuence of individual team members’ professional roles including the decision coach and organizational routines. At the macro level it acknowledges the inﬂuence of system level factors (i.e. health policies, professional organisations, and social context) on the meso and individual levels. Subsequently, the IP-SDM model will be validated with other stakeholders. Keywords: Interprofessionalism; shared decision-making; conceptual models; theories; primary care INTRODUCTION Most shared decision-making (SDM) models to date have been limited to the patient–physician dyad. For that reason, they are not always relevant to the increasingly interprofessional nature of the delivery of care. A recent systematic review identiﬁed 161 deﬁnitions of SDM in medical encounters and summarised the key elements in an integrative model (Makoul & Clayman, 2006). Neither the deﬁnitions nor the model included an interprofes- sional perspective. Marshall et al. (2005) stated that ‘‘in a world of multi-disciplinary care and substitution of medical inputs wherever appropriate, it would be timely for studies to test methods of enhancing patient involvement in decisions shared with other health-care providers’’ (p.31). Consequently, a new conceptual SDM model that explores how to involve patients in the process by which healthcare decisions are made, not with a single healthcare provider but with a team, is needed. Interprofessionalism in healthcare is a process by which professionals from different disciplines collaborate to provide an integrated and cohesive approach to patient care (D’Amour et al., 2005). SDM is deﬁned as a process by which a healthcare choice is made by a practitioner together with the patient (Towle & Godolphin, 1999) and is said to be the crux of patient-centered care (Weston, 2001). In SDM, patients are helped to be involved in decision-making and reach agreement with their practitioners about healthcare choices. An interprofessional approach to SDM could there- fore consist of an interprofessional team identifying best options and facilitating the patient’s involvement in decision- making using those options (Le´gare´ et al., 2008a). This facilitation could, but does not have to, include an intervention to support decision-making. While there is a clear need, in the current context, for a model that integrates interprofessionalism and SDM, several important issues must ﬁrst be addressed. Most SDM initiatives Correspondence: Dr. France Le´gare´, Research Center, Hoˆpital Saint-François d’Assise, Centre Hospitalier Universitaire de Que´bec, 10, de L’Espinay, Local D6-735, Que´bec G1L 3L5, Canada. Tel:þ1-418-525-4437. Fax:þ1-418-525-4194. E-mail: France.Le´gare´@mfa.ulaval.ca 18