Table 1.

The potential multilevel consequences of collaborative deliberation

Accomplishing collaborative deliberation	Proximal effects	Distal effects	Distant effects
	Informed preference; cognitive and affective effects	Cautious decisions; modified relationships; enduring trends	Modified utilization and resource use; modified help seeking behavior
Individual levels	Preferences for outcomes and treatments based on comprehension of high-quality evidence.	Collaborative deliberation generates different clinician-patient and patient-care team relationships—with positive and negative potential.	Increased use of interventions that lower risk of harms, raise likelihood of benefits.
			Lower utilization of high-risk, marginal-benefit interventions.
	Potential conflict where informed patient preference is not supported by clinician or organizational policies.
		Improved adherence to selected options and less regret about choices made, improved resilience and self-efficacy.
			Greater engagement in assessing the long-term value of interventions, leading to lower service utilization and improved self-management by patients.
	Realistic expectations with possible changes in confidence and satisfaction levels.
		Clinicians experience the synergy of working to aligned organizational-based incentives.
			Potential for reduced risk of professional burnout.
	Reduced intention to choose intensive treatment in some settings.
	Clinicians experience intrinsic reward for work done well.
	Clinicians experience the cognitive and emotional work of supporting patients making decisions.
Interactional and group levels	Enhanced relationships with clinicians and with clinical teams	Development of team culture that generates realistic expectations and judicious use of resources	Norms established: collaboration and deliberation become expected behaviors
	Dissatisfaction due to decisional burden, decisional conflict, uncertainty, and concern about honoring patient preferences.
		Patients prompted to ask questions, assess the value of interventions
		Enhanced relationships reduce complaints and legal challenges.
	Exhibiting respect for individuals’ informed preferences leads to increased satisfaction with care, at dyadic and group levels.
Organizational levels	Many clinicians in an organization become willing to share information, with patients, about alternative options.	Higher aggregate patient experience scores, e.g., satisfaction with care	Change in resource utilization requires workforce changes.
			Different utilization patterns lead to changes in delivery infrastructure and capacity.
		Higher scores on organizational measures of patient-centered care.
	Organizational commitment to resource, promote, and sustain collaborative deliberation.
		Fewer legal challenges.
		Improved staff morale, lower incidence of professional burnout, and less absenteeism.
	Redesign of workflow, space, and information systems will short term require investment.
Healthcare system level	Collaborative deliberation viewed as normative, therefore embedded in policies, systems, and rewards.	Greater skepticism and scrutiny of new drugs, interventions, and services.	Lower resource utilization, with trends to more cost-effective care, that leads to changes in strategic investment decisions.
		Improved cost-effectiveness.	System level interest population health, and its determinants.
	Recruits learn and follow different policies.
		Reduction in malpractice costs.