Decision coaching to support shared decision making: a framework, evidence, and implications for nursing practice, education, and policy

Abstract

Background: Patients with values-sensitive health decisions frequently experience decisional conflict and require support. Decision coaching shows promise but little is known about the fit within the therapeutic relationship and factors influencing implementation of decision coaching in practice.

Aims: To offer an evidence-based decision coaching framework and explore implications for competency development and environmental infrastructures needed to facilitate client-centered decision coaching.

Methods: A review of the evidence and our experience supporting the development of a framework for decision coach-mediated shared decision making that outlines the roles of the primary practitioner, the patient, and decision coach for achieving high-quality health decisions.

Implications: Competence in providing decision coaching requires knowledge and skill building at both pre- and post-licensure levels. Practice environments, regulatory bodies, educational systems, and professional and accreditation organizations are vital to successful integration of decision coaching skills into practice. Practical, visible, accessible, evidence-based, and equitably enforced regulations and policies endorsing patients' decision support interventions are essential.

Conclusions: Enhancing nurses' coaching skills for supporting patients and their families in decision making can be fostered through interventions aimed at the nurses, educational systems, and regulatory organizations. Further research and pragmatic evaluation are needed to better support the acquisition and implementation of decision coaching for all types of health decisions. APPLICATION TO NURSING PRACTICE: The framework indicates the practitioner's role in diagnosing the problem, providing options, and screening for decisional conflict. Decision coaching involves assessing factors influencing patients' decisional conflict, providing support to address decisional needs, monitoring progress in decision making, and screening for factors influencing implementation. Informed patients share their values and preferences shaped by their personal situation.