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Review
. 2022 Oct 8;22(1):265.
doi: 10.1186/s12911-022-02007-0.

Understanding how and under what circumstances decision coaching works for people making healthcare decisions: a realist review

Junqiang Zhao  1 , Janet Jull  2 , Jeanette Finderup  3   4   5 , Maureen Smith  6 , Simone Maria Kienlin  7   8 , Anne Christin Rahn  9 , Sandra Dunn  1   10   11   12 , Yumi Aoki  13 , Leanne Brown  14 , Gillian Harvey  15 , Dawn Stacey  16   17
Affiliations
Review

Understanding how and under what circumstances decision coaching works for people making healthcare decisions: a realist review

Junqiang Zhao et al. BMC Med Inform Decis Mak. .

Abstract

Background: Decision coaching is non-directive support delivered by a trained healthcare provider to help people prepare to actively participate in making healthcare decisions. This study aimed to understand how and under what circumstances decision coaching works for people making healthcare decisions.

Methods: We followed the realist review methodology for this study. This study was built on a Cochrane systematic review of the effectiveness of decision coaching interventions for people facing healthcare decisions. It involved six iterative steps: (1) develop the initial program theory; (2) search for evidence; (3) select, appraise, and prioritize studies; (4) extract and organize data; (5) synthesize evidence; and (6) consult stakeholders and draw conclusions.

Results: We developed an initial program theory based on decision coaching theories and stakeholder feedback. Of the 2594 citations screened, we prioritized 27 papers for synthesis based on their relevance rating. To refine the program theory, we identified 12 context-mechanism-outcome (CMO) configurations. Essential mechanisms for decision coaching to be initiated include decision coaches', patients', and clinicians' commitments to patients' involvement in decision making and decision coaches' knowledge and skills (four CMOs). CMOs during decision coaching are related to the patient (i.e., willing to confide, perceiving their decisional needs are recognized, acquiring knowledge, feeling supported), and the patient-decision coach interaction (i.e., exchanging information, sharing a common understanding of patient's values) (five CMOs). After decision coaching, the patient's progress in making or implementing a values-based preferred decision can be facilitated by the decision coach's advocacy for the patient, and the patient's deliberation upon options (two CMOs). Leadership support enables decision coaches to have access to essential resources to fulfill their role (one CMOs).

Discussion: In the refined program theory, decision coaching works when there is strong leadership support and commitment from decision coaches, clinicians, and patients. Decision coaches need to be capable in coaching, encourage patients' participation, build a trusting relationship with patients, and act as a liaison between patients and clinicians to facilitate patients' progress in making or implementing an informed values-based preferred option. More empirical studies, especially qualitative and process evaluation studies, are needed to further refine the program theory.

Keywords: Decision coaching; Program theory; Realist review; Shared decision making.

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Conflict of interest statement

Dawn Stacey is a Professor in the School of Nursing at the University of Ottawa and Senior Scientist at the Ottawa Hospital Research Institute where she conducts funded studies to evaluate the effectiveness of patient decision aids and decision coaching. The institution where she is employed, the University of Ottawa, has received funding to support her research studies from national granting agencies and cancer programs. She received funding to travel for the Shared Decision Making Advisory Board Meeting in Vejle, Denmark, working with Safer Care Victoria in Melbourne, Australia, meetings and training for the Joint Commission of Taiwan. Other authors declare no competing interests. Anne Christin Rahn was the co-author of two included studies; Leanne Brown was the co-author of two included studies; other authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow diagram of the project
Fig. 2
Fig. 2
PRISMA diagram
Fig. 3
Fig. 3
Refined program theory of decision coaching
See this image and copyright information in PMC

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References

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