Background
Methods
Search strategy
Selection criteria
Study identification and data extraction
Knowledge | |
---|---|
Lack of awareness | Inability to correctly acknowledge the existence of shared decision-making (SDM) [27] |
Lack of familiarity | Inability to correctly answer questions about SDM content, as well as self-reported lack of familiarity [27] |
Forgetting | Inadvertently omitting to implement SDM [41] |
Attitudes
| |
Lack of agreement with specific components of shared decision-making | |
• Interpretation of evidence | Not believing that specific elements of SDM are supported by scientific evidence [27] |
• Lack of applicability | |
○ Characteristics of the patient | Lack of agreement with the applicability of SDM to practice population based on the characteristics of the patient [27] |
○ Clinical situation | Lack of agreement with the applicability of SDM to practice population based on the clinical situation [27] |
• Asking patient about his/her the preferred role in decision-making | Lack of agreement with a specific component of SDM such as asking patients about their preferred role in decision-making [27] |
• Asking patient about support or undue pressure | Lack of agreement with a specific component of SDM such as asking patients about support and/or undue pressure [27] |
• Asking about values/clarifying values | Lack of agreement with a specific component of SDM such as asking patients about values [27] |
• Not cost-beneficial | Perception that there will be increased costs if SDM is implemented [28] |
• Lack of confidence in the developers | Lack of confidence in the individuals who are responsible for developing or presenting SDM [27] |
Lack of agreement in general | |
• "Too cookbook" – too rigid to be applicable | Lack of agreement with SDM because it is too artificial [27] |
• Challenge to autonomy | Lack of agreement with SDM because it is a threat to professional autonomy [27] |
• Biased synthesis | Perception that the authors were biased [27] |
• Not practical | Lack of agreement with SDM because it is unclear or impractical to follow [28] |
• Total lack of agreement with using the model (not specified why) | Lack of agreement with SDM in general (unspecified) [27] |
Lack of expectancy | |
• Patient's outcome | Perception that performance following the use of SDM will not lead to improved patient outcome [27] |
• Health care process | Perception that performance following the use of SDM will not lead to improved health care process [28] |
• Feeling expectancy | Perception that performance following the use of SDM will provoke difficult feelings and/or does not take into account existing feelings [28] |
Lack of self-efficacy | Belief that one cannot perform SDM [27] |
Lack of motivation | Lack of motivation to use SDM or to change one's habits [27] |
Behaviour
| |
External barriers | |
• Factors associated with patient | |
○ Preferences of patients | Perceived inability to reconcile patient preferences with the use of SDM [27] |
• Factors associated with shared decision-making as an innovation | |
○ Lack of triability | Perception that SDM cannot be experimented with on a limited basis [30] |
○ Lack of compatibility: | Perception that SDM is not consistent with one's own approach [30] |
○ Complexity | Perception that SDM is difficult to understand and to put into use [30] |
○ Lack of observability | Lack of visibility of the results of using SDM [30] |
○ Not communicable | Perception that it is not possible to create and share information with one another in order to reach a mutual understanding of SDM [30] |
○ Increased uncertainty | Perception that the use of SDM will increase uncertainty (for example, lack of predictability, of structure, of information [30] |
○ Not modifiable/way of doing it | Lack of flexibility in the degree to which SDM is not changeable or modifiable by a user in the process of its adoption and implementation [30] |
• Factors associated with environmental factors | |
○ Time pressure | Insufficient time to put SDM into practice [30] |
○ Lack of resources | Insufficient materials or staff to put SDM into practice [28] |
○ Organizational constraints | Insufficient support from the organization |
○ Lack of access to services | Inadequate access to actual or alternative health care services to put SDM into practice [28] |
○ Lack of reimbursement | Insufficient reimbursement for putting SDM into practice [28] |
○ Perceived increase in malpractice liability | Risk of legal actions is increased if SDM is put into practice [28] |
○ Sharing responsibility with Patient* | Using SDM lowers the responsibility of the health professional because it is shared with patient |
Quality assessment
Results
Included studies
Study characteristics
Quality assessment of included studies
Qualitative studies | ||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Study identification | ||||||||||||||||||
Criteria | [60] | [37] | [38] | [39] | [29] | [41] | [43] | [44] | [45] | [51] | [54, 55] | [58] | [59] | [47] | [48] | [49] | [56] | [50] |
Question/objective sufficiently described? | 2 | 2 | 2 | 2 | 2 | 1 | 2 | 0 | 2 | 2 | 2 | 2 | 1 | 2 | 2 | 2 | 2 | 2 |
Study design evident and appropriate? | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 0 | 2 | 2 | 2 | 1 | 1 | 1 | 1 | 2 | 1 | 2 |
Context for the study clear? | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 1 | 2 | 1 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 |
Connection to a theoretical framework/wider body of knowledge? | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 0 | 1 | 1 | 2 | 2 | 2 | 1 | 1 | 2 | 2 | 2 |
Sampling strategy described, relevant and justified? | 1 | 1 | 1 | 1 | 1 | 2 | 1 | 0 | 2 | 2 | 1 | 1 | 1 | 1 | 1 | 2 | 1 | 2 |
Data collection methods clearly described and systematic? | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 0 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 1 | 2 |
Data analysis clearly described and systematic? | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 0 | 2 | 2 | 2 | 2 | 1 | 2 | 1 | 2 | 0 | 2 |
Use of verification procedure(s) to establish credibility? | 0 | 2 | 2 | 0 | 1 | 0 | 1 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Conclusions supported by the results? | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 1 | 2 | 2 | 2 | 2 | 2 | 0 | 2 |
Reflexivity accounted for? | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Total score/possible maximum score
|
15/20
|
17/20
|
17/20
|
15/20
|
16/20
|
15/20
|
16/20
|
3/20
|
16/20
|
14/20
|
14/20
|
14/20
|
12/20
|
13/20
|
12/20
|
16/20
|
9/20
|
16/20
|
Quantitative studies
| ||||||||||||||||||
Study identification
| ||||||||||||||||||
Criteria
|
[53]
|
[33]
|
[34]
|
[40]
|
[11]
|
[46]
| ||||||||||||
Question/objective sufficiently described? | 2 | 2 | 2 | 2 | 2 | 2 | ||||||||||||
Study design evident and appropriate? | 2 | 2 | 2 | 2 | 2 | 2 | ||||||||||||
Method of subject/comparison group selection or source of information/input variables described and appropriate? | 1 | 2 | 2 | 1 | 2 | 2 | ||||||||||||
Subject (and comparison group, if applicable) characteristics sufficiently described? | 2 | 2 | 2 | 2 | 2 | 2 | ||||||||||||
If interventional and random allocation was possible, was it described? | N/A | N/A | N/A | N/A | N/A | N/A | ||||||||||||
If interventional and blinding of investigators was possible, was it reported? | N/A | N/A | N/A | N/A | N/A | N/A | ||||||||||||
If interventional and blinding of subjects was possible, was it reported? | N/A | N/A | N/A | N/A | N/A | N/A | ||||||||||||
Outcome and (if applicable) exposure measure(s) well-defined and robust for measurement/misclassification bias? Means of assessment reported? | 2 | 2 | 2 | 2 | 2 | 2 | ||||||||||||
Sample size appropriate? | N/A | N/A | N/A | N/A | N/A | N/A | ||||||||||||
Analytic methods described/justified and appropriate? | 2 | 2 | 2 | 2 | 2 | 2 | ||||||||||||
Some estimate of variance is reported for the main results? | N/A | 2 | 0 | 2 | 2 | 1 | ||||||||||||
Controlled for confounding? | N/A | N/A | N/A | N/A | N/A | N/A | ||||||||||||
Results reported in sufficient detail? | 2 | 2 | 2 | 2 | 2 | 2 | ||||||||||||
Conclusions supported by the results? | 2 | 2 | 2 | 2 | 2 | 2 | ||||||||||||
Total score/possible maximum score
|
15/16
|
18/18
|
16/18
|
17/18
|
18/18
|
17/18
| ||||||||||||
Mixed methods studies
| ||||||||||||||||||
Study identification
| ||||||||||||||||||
[21, 35, 36]
|
[42]
|
[57]
|
[52]
| |||||||||||||||
Assessment of the qualitative component of the study
| ||||||||||||||||||
Criteria
| ||||||||||||||||||
Question/objective sufficiently described? | 2 | 2 | 2 | 2 | ||||||||||||||
Study design evident and appropriate? | 2 | 2 | 2 | 2 | ||||||||||||||
Context for the study clear? | 2 | 2 | 2 | 2 | ||||||||||||||
Connection to a theoretical framework/wider body of knowledge? | 2 | 2 | 2 | 2 | ||||||||||||||
Sampling strategy described, relevant and justified? | 1 | 1 | 1 | 1 | ||||||||||||||
Data collection methods clearly described and systematic? | 2 | 2 | 2 | 2 | ||||||||||||||
Data analysis clearly described and systematic? | 2 | 2 | 2 | 2 | ||||||||||||||
Use of verification procedure(s) to establish credibility? | 0 | 2 | 0 | 0 | ||||||||||||||
Conclusions supported by the results? | 2 | 2 | 2 | 2 | ||||||||||||||
Reflexivity of the account? | 0 | 2 | 0 | 0 | ||||||||||||||
Assessment of the quantitative component of the study
| ||||||||||||||||||
Question/objective sufficiently described? | 2 | 2 | 2 | 2 | ||||||||||||||
Study design evident and appropriate? | 2 | 2 | 2 | 2 | ||||||||||||||
Method of subject/comparison group selection or source of information/input variables described and appropriate? | 1 | 2 | 1 | 2 | ||||||||||||||
Subject (and comparison group, if applicable) characteristics sufficiently described? | 2 | 2 | 2 | 2 | ||||||||||||||
If interventional and random allocation was possible, was it described? | 2 | N/A | N/A | N/A | ||||||||||||||
If interventional and blinding of investigators was possible, was it reported? | 2 | N/A | N/A | N/A | ||||||||||||||
If interventional and blinding of subjects was possible, was it reported? | 2 | N/A | N/A | N/A | ||||||||||||||
Outcome and (if applicable) exposure measure(s) well-defined and robust for measurement/misclassification bias? Means of assessment reported? | 2 | 2 | 2 | 2 | ||||||||||||||
Sample size appropriate? | 2 | N/A | 2 | N/A | ||||||||||||||
Analytic methods described/justified and appropriate? | 2 | 2 | 1 | N/A | ||||||||||||||
Some estimate of variance is reported for the main results? | 2 | 2 | 1 | N/A | ||||||||||||||
Controlled for confounding? | 1 | N/A | 1 | N/A | ||||||||||||||
Results reported in sufficient detail? | 2 | 2 | 2 | 2 | ||||||||||||||
Conclusions supported by the results? | 2 | 2 | 2 | 2 | ||||||||||||||
Total score/possible maximum score
|
41/48
|
37/38
|
33/42
|
29/34
|
Barriers and facilitators
Factor as a barrier/facilitator | Barriers (number of studies in which this factor was identified as a barrier) [reference number] | Facilitators (number of studies in which this factor was identified as a facilitator) [reference number] |
---|---|---|
Knowledge
| ||
Lack of awareness/awareness | 0 | 0 |
Lack of familiarity/familiarity | 5 [29, 37, 39, 44, 49] | 0 |
Forgetting | 1 [41] | Not applicable |
Attitude
| ||
Lack of agreement with specific components of shared decision-making/agreement with specific components of shared decision-making
| ||
• Interpretation of evidence | 1 [29] | |
• Lack of applicability/applicability | ||
○ Characteristics of the patient | 12 [21, 29, 34, 37, 41, 43, 47-49, 53-55, 59] | 4 [29, 35, 51, 54, 55] |
○ Clinical situation | 12 [11, 29, 34, 36-38, 47-49, 53-55, 59] | 3 [37, 46, 51] |
• Asking patient about his/her preferred role in decision-making | 7 [11, 38, 40, 42, 43, 50, 59] | 2 [42, 50] |
• Asking patient about support or undue pressure | 0 | 1 [34] |
• Asking about values/clarifying values | 0 | 0 |
• Not cost-beneficial/Cost-beneficial | 3 [21, 29, 45] | 1 [42] |
• Lack of confidence in the developers/Confidence in the developers | 0 | 1 [29] |
Lack of agreement in general/Agreement in general
| ||
• "Too cookbook" – too rigid to be applicable | 2 [29, 48] | 0 |
• Challenge to autonomy | 1 [11] | 0 |
• Biased synthesis | 1 [29] | 0 |
• Not practical/Practical | 2 [29, 54, 55] | 6 [29, 33, 41, 54-57] |
• Total lack of agreement with using the model (not specified why) | 2 [47, 50] | 0 |
Lack of expectancy/expectancy
| ||
• Patient's outcome | 1 [33] | 10 [33, 34, 37, 42, 46, 50-52, 54-56] |
• Process expectancy | 1 [56] | 11 [11, 29, 33, 34, 36, 41, 42, 50, 51, 54, 55, 57] |
• Feeling expectancy | 0 | 1 [34] |
Lack of self-efficacy/Self-efficacy | 6 [21, 34, 37, 48, 50, 53] | 0 |
Lack of motivation/Motivation | 4 [21, 37, 51, 52] | 15 [33, 35, 36, 38, 39, 41-44, 47, 49, 51, 52, 54, 55, 57, 58] |
Behaviour
| ||
External factors | ||
• Factors associated with patient | ||
○ Preferences of patients | 9 [21, 39, 41, 42, 45, 47, 48, 52, 54, 55] | 4 [34, 39, 42, 52] |
• Factors associated with shared decision-making as an innovation | ||
○ Lack of triability/Triability | 2 [29, 49] | 1 [29] |
○ Lack of compatibility/Compatibility: | 2 [29, 33] | 2 [29, 33] |
○ Complexity/Ease of use | 3 [21, 29, 45] | 2 [29, 56] |
○ Lack of observability/Observable | 1 [29] | 1 [29] |
○ Not communicable/Communicable | 3 [29, 38, 49] | 0 |
○ Increase uncertainty/Decrease or manage one's own uncertainty | 1 [45] | 1 [37] |
○ Not modifiable/Modifiable | 1 [37] | 1 [29] |
• Factors associated with environmental factors | ||
○ Time pressure/Save time | 18 [29, 34-39, 41-43, 47, 48, 50, 51, 53-57, 60] | 3 [29, 42, 54, 55] |
○ Lack of resources/Resources | 4 [35, 47, 50, 53] | 1 [50] |
○ Organizational constraints/Organizational support | 0 | 0 |
○ Lack of access to services/Access to services | 2 [41, 60] | 0 |
○ Lack of reimbursement/Reimbursement | 0 | 0 |
○ Perceived increase in malpractice liability/Perceived decrease in malpractice liability | 2 [47, 48] | 0 |
○ Sharing responsibility with Patient | Not applicable | 3 [37, 42, 51] |