Shared decision making for people living with multimorbidity: A concept analysis

Objective: As part of patient-centered care, shared decision making (SDM)-where healthcare professionals (HCPs) and patients collaboratively choose treatments based on medical evidence and patient preferences-is essential for patients with multimorbidity facing varied benefits and risks. However, there is no clear conceptual understanding of what it represents. This study aims to analyze SDM concept for individuals with multimorbidity, clarifying key elements and guiding effective patient engagement in complex care decisions. Methods: A concept analysis was undertaken using Walker and Avant's approach based on a literature review. Results: SDM is a fundamental concept in health promotion for people with multimorbidity, assisting patients and HCPs in defining priorities, making choices, developing strategies, and executing them to improve health. Four core attributes were identified: (1) partnership based on mutual trust; (2) multidimensional information exchange; (3) complex trade-offs; (4) iterative communication and evaluation. Antecedents were divided into factors (complexity of diseases and multiple health needs from patients; communication skills from HCPs; consultation time, training and policy from health system). Consequences included patient autonomy and improved decision-making quality, patient satisfaction and symptom relief, and efficient utilization of medical resources. Conclusions: Our findings offer insights into refining the concept of SDM in the context of multimorbidity. This concept analysis serves as a foundation for instrument development to measure the effects or attributes of the concept and highlights the need for future practical research on SDM that goes beyond involvement and engagement. Practice implications: To implement SDM effectively for multimorbid patients, healthcare systems should enhance HCPs' communication skills, allocate sufficient consultation time to address complex needs, support SDM through policy, and develop tools to assess decision quality, patient satisfaction, and medical resource utilization.