The actor-partner interdependence model in shared decision-making: an illustrative example of its application to the physician-patient dyad in primary care consultations

J Clin Epidemiol. 2019 Apr;108:132-139. doi: 10.1016/j.jclinepi.2018.11.027. Epub 2018 Dec 7.


Objectives: We applied the actor-partner interdependence model, a method used to evaluate the relationship process between two related persons, to patient-physician data about the effect of shared decision-making behaviors on patient and physician uncertainty. We discuss measurement and interpretation problems.

Study design and setting: The EXACKTE2 project was a cross-sectional study of 263 unique patient-physician dyads in 17 primary care clinics in Canada. Participants independently completed self-administered questionnaires postconsultation to measure patients' and physicians' perceptions of shared decision-making behaviors and their uncertainty about whether the decision was the best one for the patient. We used the actor-partner interdependence model to explore the effect of shared decision-making behaviors on patient and physician uncertainty.

Results: Application of the actor-partner interdependence model to our data showed significant actor effects only. Our exploratory analysis suggested that an appropriate dyadic pattern for this context would be the couple-oriented model.

Conclusion: Each actor's perception of the physicians' shared decision-making behaviors appeared only to affect their own uncertainty (actor effects), but the questionnaire may have been inadequate for identifying partner effects. Researchers should further explore using the actor-partner interdependence model to analyze actor-partner interdependence in the physician-patient relationship, and format questions tailored precisely to the model.

Keywords: Actor–partner interdependence model; Dyadic measures; Measurement problem; Patient–physician dyad; Shared decision-making; Uncertainty.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cross-Sectional Studies
  • Decision Making*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Models, Psychological*
  • Patients / psychology*
  • Perception
  • Physician-Patient Relations*
  • Physicians, Primary Care / psychology*
  • Primary Health Care / methods*