Shared decision-making, the working alliance, and patient-centered care: A simultaneous concept analysis and review of the literature
Bibliographic record
Abstract
OBJECTIVE: To identify the conceptual similarities, differences, and interrelationships between shared decision-making (SDM), the working alliance, and patient-centered care (PCC) in primary care. METHODS: This study is a simultaneous concept analysis based on the method of Walker and Avant (2005) and Haase et al. (1992). First, a systematic search was conducted for articles published between 2012 and 2022 to identify those describing definitions, antecedents, attributes, consequences, and empirical referents of any of the three concepts. Then, data was extracted and organized into a validity matrix for comparison. RESULTS: Shared decision-making is a procedural communicative process involving both providers and patients in making clinical decisions. The working alliance between the patient and provider serves as a relational model foundational to the patient-provider relationship. Patient-centered care is an approach or philosophy adopted by clinicians (dyadic PCC) or organizations (organizational PCC) that shapes how care is conceptualized and delivered. Collaboration, common ground, integration of patient preferences, and information exchange are integral to all three concepts but are emphasized to varying degrees. PCC can be applied unilaterally, while SDM and the working alliance are always relational. Overall, the working alliance establishes the context in which providers adopt a patient-centered approach and can practice SDM. CONCLUSIONS: Shared decision-making, the working alliance, and patient-centered care are distinct concepts but are intrinsically interrelated in both theory and practice. The working alliance can be described as a relational "setting" where PCC (an approach to care) can be applied and SDM (a conversational model) can be practiced. Practice implications This study contributes to enhancing the conceptual clarity of the three concepts in the primary care, which may facilitate better operationalization and subsequent care design.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.028 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.018 | 0.021 |
| Science and technology studies | 0.002 | 0.004 |
| Scholarly communication | 0.006 | 0.008 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".