What value structure underlies shared decision making? A qualitative synthesis of models of shared decision making

To construct the underlying value structure of shared decision making (SDM) models. We included previously identified SDM-models (n=40) and 15 additional ones. Using a thematic analysis, we coded the data using Schwartz's value theory to define values in SDM and to investigate value relations. We identified and defined eight values and developed three themes based on their relations: shared control, a safe and supportive environment, and decisions tailored to patients. We constructed a value structure based on the value relations and themes: the interplay of HCPs' and patients' skills Achievement, support for a patient Benevolence, and a good relationship between HCP and patient Security all facilitate patients' autonomy Self-Direction. These values enable a more balanced relationship between HCP and patient and tailored decision making Universalism. SDM can be realized by an interplay of values. The values Benevolence and Security deserve more explicit attention, and may especially increase vulnerable patients' Self-Direction. This value structure enables a comparison of values underlying SDM with those of specific populations, facilitating the incorporation of patients' values into treatment decision making. It may also inform the development of SDM measures, interventions, education programs for SDM, and HCPs when practicing.