Background
Methods
Search strategy
Eligibility criteria
Study selection
Data extraction and quality assessment
Results
Study selection
Study characteristics
First author | Setting | Country | Design study | Reporting focusa: Barriers (B) and/or Facilitators (F) | Perspectiveb | Participants (n) | % Female | Mean age of patients (years) (if not available: age range) |
---|---|---|---|---|---|---|---|---|
Funk [41], 2004 | LTC facilities | Canada | Qualitative | B&F | Patients | 100 patients | 82 | 85 |
Gauthier [42], 2005 | hospital | U.S.A. | Qualitative | B&F | Patients | 13 patients | 62 | 72 |
Naik [43], 2011 | primary care | U.S.A. | Quantitative | B | Patients | 100 patients | 100 | 71 |
Belcher [44], 2006 | primary care | U.S.A. | Qualitative | B&F | Patients | 51 patients, | 63 | 77 |
Chi [45], 2017 | community care | U.S.A. | Quantitative | B | Patients | 2017 patients | 57 | range 65 > 85 |
Dyrstad [46], 2015 | hospital | Norway | Qualitative | B&F | Patients | 41 patients | 46 | 86 |
Ekdahl [47], 2010 | hospital | Sweden | Qualitative | B&F | Patients | 15 patients | 67 | 84 |
Ekdahl [48], 2011 | hospital | Sweden | Quantitative | B | Patients | 156 patients | 49 | 83.1 |
Erickson [49], 1989 | community care | U.S.A. | Qualitative (case study) | B | Patients | 1 patient | 100 | 75 |
Petrillo [50], 2018 | hospital | U.S.A. | Qualitative | F | Patients and informal caregivers | 38 patients 31 informal caregivers | 48 (total group) | 78 |
Riffin [51], 2018 | primary care | U.S.A. | Qualitative | B | Patients and informal caregivers | 20 patients 20 informal caregivers | 61 65 | 82 |
Kiselev [52], 2017 | hospital & community care | Germany | Mixed methods | B&F | Patients and health professionals | 283 patients 14 professionals (clinicians, nurses, therapists, psychologist, social worker) | 66 unkc. | 74.4 |
Rose [53], 2018 | rehabilitation | U.K. | Mixed methods | B | Patients and health professionals | 40 patients 24 professionals (rehabilitation staff) | 23 unk. | 83 |
Ferris [54], 2018 | health care users and providers | U.S.A. | Qualitative | B&F | Patients, informal caregivers and health professionals | 6 patients or informal caregivers 30 clinicians, health systems, and payers | unk. | unk. |
Doekhie [55] | primary care | The Netherlands | Qualitative | B | Patients, informal caregivers and health professionals | 19 patients 10 informal caregivers 38 professionals (clinicians, nurses, paramedics) | 79 40 unk. | 81.6 |
Puts [56], 2017 | hospital | Canada | Mixed methods | B | Patients, informal caregivers and health professionals | 29 patients 24 informal caregivers 28 professionals (oncologists and family physicians) | 24 resp. 36 | patients divided in 2 age groups: 63–79 & > 80; |
Bragstad [57], 2014 | hospital | U.S.A. | Qualitative | B | Informal caregivers | 19 informal caregivers | 68 | n.a.d |
Menne [58], 2008 | community care | U.S.A. | Quantitative | B&F | Informal caregivers | 215 informal caregivers | 50 | n.a. |
Peacock [59], 2017 | community care | Canada | Qualitative | B | Informal caregivers | 18 informal caregivers | 44 | n.a. |
Ekdahl [60],2012 | hospital | Sweden | Qualitative | B&F | Health professionals | 29 physicians | 34 | n.a. |
Fried [61], 2011 | primary care | U.S.A. | Qualitative | B | Health professionals | 40 physicians | n.a. | |
Blaum [62], 2018 | primary care & hospital | U.S.A. | Qualitative | B | Health professionals | 9 general practitioners, 5 cardiologists | n.a. | |
Gopalraj [63], 2012 | hospital | U.S.A. | Qualitative (case study) | B&F | Health professionals | 1 patient | 100 | 94 |
Milte [64], 2015 | geropsychiatry inpatient unit | Australia | Quantitative | B | Health professionals | 2 geriatricians | 59 | n.a. |
Schuling [65], 2012 | hospital | The Netherlands | Qualitative | B | Health professionals | 13 physicians | 15 | n.a. |
Molinari [66], 2016 | geropsychiatry inpatient unit | U.S.A. | Qualitative (case study) | F | Health professionals | 1 patient | 0 | ‘late 60s’ |
Légaré [67], 2013 | primary care | Canada | Mixed methods | B&F | Health professionals | Participants: a) 276 home care providers b) 7 members health care team c) 8 managers | Participants: a) 82 b)100 c) 50 | n.a. |
Lindhardt [68], 2008 | hospital | Sweden | Qualitative | B&F | Health professionals | 8 nurses | 100 | n.a. |
Quality assessment
Barriers and facilitators of SDM for older patients with MCCs
Factor | Barriers (number of studies in which this factor was identified as a barrier) | Facilitators (number of studies in which this factor was identified as a facilitator) | |
---|---|---|---|
Predisposing factors | Patient characteristics | Being in poor health: 13 Cognitive/physical impairments: 13 Lower level of education: 5 Age: 4 Poor articulation: 4 Difference in personal characteristics: None Health condition - stigma/discrimination: 2 Ethnicity: 1 Long term patient: 1 | Prior exposure to illness/decision making point: 4 Personal values: 1 Being in good health: 1 Long term patient: Nonea |
Decision characteristics | Disease-based decision models (guidelines): 3 Burden of treatment regimen: 2 Shock of receiving diagnosis: 2 Minor decision: 1 Timing along the illness trajectory: None Major decision: None Embarrassing or sensitive topics: None | When decisions are allowed that are inconsistent with guidelines: 1 Major decision: 1 Timing along the illness trajectory: None Minor decision: None Time to come to terms with diagnosis: None | |
Interactional context factors | Power (im) balance in the patient-clinician relationship | Presumptions about the patient role Not having explicit ‘permission’ to participate in SDM: 6 Expectation of the clinician making the decisions: 2 Desire to act as a ‘good’ patient (driven by fear of consequences): 1 Belief that clinicians do not want patients involved: 1 Perceived acceptability of asking the clinician questions: 1 Clinicians reinforces passivity by rewarding the behaviour: None Patients undervalue their expertise relative to clinicians ‘Doctor knows best’ and patients have ‘inferior’ knowledge: 3 Patients are not capable of understanding medical/technical information: 2 | Presumptions about the patient role Having explicit ‘permission’ to participate in SDM: 4 Perceived acceptability of asking the clinician questions: None Patients undervalue their expertise relative to clinicians Recognizing there are two experts in the medical encounter: 5 |
Interpersonal characteristics of the clinician | Clinicians with poor interpersonal skills: 5 Authoritarian HCPs: 4 Clinician does not listen to patients concerns: 2 Perceptions that clinicians are already doing SDM: 1 Lack of individualized approach and not asked about preferences: 1 Clinician does not address patient directly: 1 Poor relationship with clinician: None | Individualized approach where clinician seeks patient’s preferences: 4 Clinicians with positive interpersonal skills: 2 Equal relationship: 1 Clinician listens to patients concerns: 1 Good relationship with clinician: None | |
Trust | Trust in clinician: None Lack of trust in clinician: 2 | Trust in clinician: 6 Lack of trust in clinician: None | |
Preparation for an SDM encounter | Perceived need for preparation | Patient does not want or need to participate in SDM: 4 Patient is not entitled to a choice: 1 Patient is not explicitly offered a choice or it is presented in a biased way: 1 ‘Doing nothing’ is not an option: None Not knowing what to expect from the SDM consultation: None | Accepting responsibility to be involved in decision-making: 5 Setting an agenda: 1 |
Expectation of SDM outcomes | Patient focus on treatment burden versus clinicians concerns about morbidity and mortality: 2 Not wanting responsibility for wrong decision: 1 Fear of accepting reality of diagnosis: None | Recognizing equipoise and uncertainty: 1 | |
Preparation for the SDM process | Providing information about options | Insufficient information about condition, options and outcomes: 3 Clinician does not explain the options and outcomes: 2 Clinician in repair-reflex mode (solutions without listening to patient’s preferences): 1 No flexibility of clinicians when patients want something different: 1 | Sufficient information about condition, options and outcomes: 5 Clinician explains the options and outcomes: 2 Clinician knows patient’s and informal caregivers’ priorities, goals and preferences: 1 |
Terminology used by HCPs | Clinician uses medical terminology: 1 | Clinician uses simple terminology: 1 | |
Decision support | Decision support from informal caregivers: 4 Lack of written decision support: 1 Purpose of decision support tool is unclear: None | Decision support from others (e.g., family, other professionals): 15 Written decision support: None | |
Social context | View of colleagues | Disagreement between colleagues: 3 Degree of contact between colleagues: 1 Hierarchical structure of professionals: 1 | |
Culture of network | Social norms and values: None | Social norms and values: None | |
Collaboration | Degree of cooperation and response between colleagues: 10 | Degree of cooperation and response between colleagues: 6 | |
Leadership and social learning | Lack of support from management (incentive, feedback, role models): 3 | Support from management (incentive, feedback, role models): None | |
Organizational context | Organizational characteristics | Complexity of the organization: 4 | Complexity of the organization: 1 |
Capacities | No arrangements for continuous learning: 1 | Continuous learning opportunities: None | |
Organizational constraints | Lack of resources (time): 11 Lack of support services: 2 Lack of resources (staff): 4 | Lack of resources (time): 3 Lack of support services: None Lack of resources (staff): None | |
Economic and political context | Policy | Unattractiveness of innovation by means of financial arrangements: 2 | Attractiveness of innovation by means of financial arrangements: 1 |
Other | 6 | None |