Background
Methods
Protocol design
Identifying relevant studies
Study design
Eligibility criteria
Literature review
Charting the data
Results
Summarizing, collating, and reporting the results
Summarizing the results
Article and Date of Publication | Study Population | Acuity of the Intervention | Major Findings Related to Decision Making (DM) Preferences | DM Theme Related to Major Findingsa | Factors Associated with Favoring SDM | |
---|---|---|---|---|---|---|
^PT | ^SURG | |||||
Almyroudi et al. (2011) [17] | 329 breast cancer patients | Urgent | 71.1% preferred a passive role; 24% a collaborative role;4.6% an active role | SG | – | Younger age, higher education |
Ananian et al. (2004) [18] | 181 breast cancer patients | Elective | 57% of women choosing breast reconstruction “decided with surgeon” 70% of these patients were satisfied with the information received. | SDM | – | Type of procedure |
Andersen et al. (2009) [19] | 636 breast cancer survivors | Urgent | On average, 72% reported being “very involved, I made all the decisions myself.” 80% were content with DM role. | IDM | – | Younger age, level of education, income |
Asghari et al. (2008) [20] | 299 hospitalized patients (85% on surgical wards) | Unclear | “strongly desire to receive information and participate in decision-making” | SDM | – | Female, level of education |
Ashraf et al. (2013) [21] | 465 patients undergoing either immediate or delayed breast reconstruction | Elective | 66% were in the “informed-consumerist” group when it came to actual DM. 86.3% of these patients were satisfied with the information received. | IDM | – | |
Avis (1994) [22] | 20 hernia repair patients | Elective | “expectations of participation can be summarized as ‘being told’ and ‘going in to get it fixed’” | SG | – | |
Ballinger et al. (2008) [23] | 131 breast cancer patients | Urgent | 61% “felt their healthcare professionals had surgical preferences for them, believed that clinical issues determined these preferences, but still knew the choice was theirs” | SDM | – | |
Beaver et al. (2005) [24] | 41 colorectal cancer patients | Urgent | “wanted to be well informed and involved in the consultation process but did not necessarily want to use the information they received to make decisions” | SG | – | |
Beaver et al. (2007) [25] | 35 health professionals caring for colorectal cancer patients (4 were surgeons) | Urgent | “shared decision making was favored by health professionals” | – | SDM | Younger patient age |
BeLue et al. (2004) [26] | 50 cardiologists making a decision about surgery; 92 patients with coronary artery disease | Urgent | Physicians: 74% “prefer patients who actively participate in the decision;” Patients: 50% “prefer the physician to make the decision;” 40% SDM;” 10% “prefer to make the decision on their own” | SG | SDM | |
Blumenthal-Barby et al. (2015) [27] | 30 left ventricular assist device patients and candidates | Urgent | “deferred heavily to clinicians” | SG | – | |
Burton et al. (2017) [28] | 101 older breast cancer patients | Urgent | 39% preferred “patient-centred;” 38% “doctor-centred;” 24% SDM | SG/ IDM | – | |
Butow et al. (2007) [29] | 135 patient advocates; 142 breast cancer surgeons | Urgent | 66% of surgeons and 62% of patient advocates preferred SDM | SDM | SDM | |
Campesino et al. (2012) [30] | 39 breast cancer survivors | Urgent | Spanish-speaking Latinas preferred “physician treatment recommendations;” English-speaking Latinas and African-Americans preferred SDM | SDM/ SG | – | English-speaking |
Cohen (2003) [31] | 19 patients with localized prostate cancer | Urgent | Most viewed the surgeon-guided approach as “appropriate and welcome.” | SG | – | |
Corriere et al. (2015) [32] | 81 patients undergoing elective vascular procedures | Elective | 93% preferred “choosing together with the provider;” 62% preferred “having the provider choose for them” | SDM | – | Multiple treatment options, type of procedure |
Cuypers et al. (2016) [33] | 562 prostate cancer survivors | Urgent | 59% preferred a collaborative role; 22% an active role; 19% a passive role | SDM | – | Higher education; younger age; higher SES |
Doring et al. (2014) [34] | 105 hand surgeons; 84 patients with trigger finger | Elective | Patients “preferred to decide for themselves”; surgeons preferred SDM | IDM | SDM | |
Durif-Bruckert et al. (2015) [35] | 146 breast cancer patients | Urgent | wanted to participate in decisions, but “perceived SDM as an obligation” because it did not seem to fit with their idea of a proper doctor-patient relationship | SG | – | Trust in surgeon; support from family; written information from surgeon |
Gainer et al. (2017) [36] | 15 frail and older patients; 20 care team members (includes surgeons) | Unclear | both patients and care team members “supported a formal approach” to SDM | SDM | SDM | |
Ghane et al. (2014) [37] | 380 general surgery patients | Elective | “preferred relatively high levels of decisional control on average (M = 8.95 out of 10, SD = 2.15).” | IDM | – | Male; good health; high health literacy |
Golden et al. (2017) [38] | 20 clinicians (7 were surgeons) | Urgent | Most felt that they practiced SDM, even though they did not tend to distinctly prompt patient DM preferences | – | SDM | |
Gong et al. (2011) [39] | 78 patients with carpal tunnel syndrome | Elective | 76% preferred SDM | SDM | – | History of surgical procedure; importance of family member opinions; having private insurance |
Hack et al. (2006) [40] | 205 breast cancer patients | Urgent | 42% preferred a collaborative role; 35.6% an active role; 22.4% a passive role | SDM | – | Age < 70, non-widowed, longer duration post-op |
Hageman et al. (2014) [41] | 103 hand surgeons; 79 patients with carpal tunnel syndrome | Elective | Surgeons: 74% preferred “patient and provider make a shared decision;” Patients: 59% preferred that “the patient decides” | IDM | SDM | |
Hawley et al. (2008) [42] | 925 breast cancer patients | Urgent | Actual DM role: 37% SDM; 36% “patient-based;” 27% “surgeon-based.” Preferred DM role: 93% content with level of DM involvement | SDM/ IDM | – | |
11 health professionals from 6 surgical wards; 7 patients who underwent surgical treatment | Elective | Health professionals: majority preferred a “shared” or “informed” model; Patients: about half preferred a “shared” or “informed” model and the other half preferred a “paternalistic” model | SDM/ SG | SDM | Female | |
Heggland & Hausken (2014) [45] | 7 surgical patients; 4 surgeons | Elective/ Urgent | Surgeons: the majority preferred an “informed model … patient is given information and left to make the decision;” Patients: 3 preferred a “paternalistic model” and 2 preferred shared. | SG | IDM | |
119 physicians working in 6 surgical wards | Unclear | physicians on average rated decision-making control a 4.6, which means that “physicians were not reluctant to involve patients in decision-making processes” | – | SDM | ||
Henderson & Shum (2003) [46] | 49 surgical and medical patients | Elective/ Urgent | Where 1 = active role, 3 = shared, and 5 = passive – the mean DM value for the severe scenario was 3.55; moderate scenario was 3.37; mild scenario was 3.00 | SDM | – | Younger age, non-critical condition |
Henderson et al. (2006) [47] | 186 inpatients in two surgical units | Unclear | “females indicated that they would like to have more input in the decision-making process than the males” (3.57 v. 3.81 on the Controlled Preferences Scale) | SDM | – | Female; higher education |
Hopmans et al. (2015) [48] | 87 lung cancer patients | Urgent | “guidance by the clinician” was identified as most important; “active role of patient in treatment decision making” regarded as less important | SG | – | |
Hou et al. (2014) [49] | 113 colorectal cancer patients | Urgent | 41.6% preferred a passive role; 24.8% SDM; 7.1% an active role | SG | – | Female; no stoma |
Iaccarino et al. (2017) [50] | 428 clinician members of the American Thoracic Society | Urgent | Perceived Role: 50.4% “share decisions equally with the patient”; 34.5% “allow the patient to decide;” 15.1% “decide for themselves after considering the patient’s opinion” | – | SDM | More years in practice; more comfort in pulmonary nodule management |
Ihrig et al. (2011) [51] | 31 prostate cancer patients | Urgent | “most patients wanted to decide on their treatment options together with their physician” | SDM | – | |
Janz et al. (2004) [52] | 101 breast cancer patients | Urgent | 47% preferred SDM; 38% preferred to make the decision “with physician input” | SDM | – | College degree; higher self-efficacy |
Johnson et al. (1996) [53] | 76 newly diagnosed breast cancer patients | Urgent | “74% wanted their surgeons to make a recommendation and when given, 94% followed the recommended treatment plan” | SG | – | |
Keating et al. (2002) [54] | 1081 breast cancer patients | Urgent | 64% preferred a collaborative role | SDM | – | |
Keating et al. (2010) [55] | 5383 lung or colorectal cancer patients | Urgent | 38.9% = “patient controlled,” 43.6% = SDM; 17.5% = “physician controlled” | SDM | – | Married, better pre-diagnosis health status, Caucasian, strong evidence for procedure |
Lally (2009) [56] | 18 breast cancer patients | Urgent | “women’s lack of sharing their preferences with their surgeons and the surgeons’ lack of making treatment recommendations resulted in what was more likely informed than shared decision making” | IDM | – | |
Lam et al. (2003) [57] | 154 breast cancer patients | Urgent | 59% preferred SDM; 33% preferred “the choice to be their own;” 8% preferred “to delegate the decision” | SDM | – | Younger age |
Lantz et al. (2005) [58] | 1633 breast cancer patients | Urgent | Actual Role: 36.9% SDM; 37.9% made decision with “surgeon input.” 69% were satisfied with DM level. | SDM | – | |
Larsson et al. (1989) [59] | 666 patients scheduled for invasive surgery | Elective | Actual DM: 41% “joint patient-doctor decision;” 29% “doctor advocated;” 8% “patient asked.” Preferred DM: 73% content with level of DM involvement | SDM | – | Female |
Lee et al. (2012) [60] | 82 patients with early gastric cancer | Urgent | The surgical group showed a more passive role in both their preferred and actual DM role | SG | – | |
Markovic et al. (2006) [61] | 30 newly diagnosed gynecologic cancer patients | Urgent | “surgeon’s recommendation and fear of dying from cancer” played the most important role in DM | SG | – | |
Martinez et al. (2016) [62] | 1690 newly diagnosed breast cancer patients | Urgent | In surgery, 51% preferred a “directive” communication style; 49% a “non-directive” communication style | SDM/ SG | ||
McGuire et al. (2005) [63] | 18 surgeons | Unclear | “Many physicians saw their role as an expert who educates the patient but retains control over the decision-making process; others took a more collaborative approach, encouraging patients to assume decisional priority” | – | SDM/ SG | Multiple treatment options, increased risk, impact of procedure on patient lifestyle, moral content |
Mendick et al. (2010) [64] | 20 breast cancer patients; 8 surgeons | Urgent | Surgeons: “made most decisions for patients;” Patients: “generally lacked trust in their own decisions and usually sought surgeons’ guidance” | SG | SG | Patients: strong evidence for procedure; Surgeons: multiple treatment options, impact of procedure on patient lifestyle |
Meredith (1993) [65] | 30 surgical patients; 14 surgeons | Unclear | Patients: “majority agreed that the surgeon should supply them with the ‘pros’ and ‘cons’ of all measures to address the problem, and it was for them ultimately to decide what was right for them;” Surgeons: “not enthusiastic at the prospect of devoting more time to discussing surgical alternatives, risks and complications, and outlook indicators for their patients benefit” | SDM | SG | |
Morgan et al. (2015) [66] | 729 older breast cancer patients | Urgent | In surgery, 41.6% preferred SDM; 34.7% a “doctor-centered” approach; “23.7% a “patient-centered” approach | SDM | – | Older age |
Morishige et al. (2017) [67] | 1035 patients with irritable bowel disease | Elective | 56% “thought having a physician involve them in the decisions concerning their treatment was very important” | SDM | – | Comorbidities, surgical history; use of biologics, treated at an academic hospital, being married |
Moumjid et al. (2003) [68] | 22 breast cancer patients | Urgent | “most were satisfied with the information given and the possibility of participating to the treatment decision-making process” | SDM | – | |
Nam et al. (2014) [69] | 85 patients with carpal tunnel syndrome | Elective | “I prefer that my doctor and I share responsibility” = 29%; ““I prefer that my doctor makes the final decision about which treatment will be used but seriously considers my opinion = 35% | SDM | – | |
Omar et al. (2016) [70] | 100 consecutive patients being seen in a multi-disciplinary stone clinic | Elective | 85% “would rely on the physician’s recommendation” | SG | – | |
Op den Dries et al. (2014) [71] | 219 liver transplant candidates and recipients | Urgent | “79.8% wished to be involved in making the decision to accept or not accept a liver for transplantation” | SDM | – | |
Orsino et al. (2003) [72] | 197 end stage renal disease patients | Elective | 41.5% preferred “equal responsibility;” 34.5% an “autonomous” role; 23.9% a decision driven by the health care team | SDM | – | Younger age |
Pieterse et al. (2008) [73] | 70 rectal cancer patients; 25 surgical oncologists | Urgent | The majority of patients and clinicians preferred SDM. | SDM | SDM | Patients: Female, higher education |
Ramfelt et al. (2005) [74] | 55 rectal or colon cancer patients | Urgent | 71% of rectal cancer patients & 75% of colon cancer patients preferred a collaborative role | SDM | – | Younger age |
Ratsep et al. (2014) [75] | 150 patients with lumbar disc herniation | Elective | 47% preferred SDM | SDM | – | Desire for more disease specific information |
Salkeld et al. (2004) [76] | 175 rectal or colon cancer patients | Urgent | 54% preferred a surgeon-guided approach; 29% SDM; 15% a more independent DM role | SG | – | Female, younger age, history of radiation |
Santema et al. (2017) [77] | 67 patients with either abdominal aortic aneurysm or peripheral arterial occlusive disease | Elective | 58% preferred SDM | SDM | – | Trust in doctor, doctor has a clear communication style, doctor listens, enough time for consultation |
Seror et al. (2013) [78] | 415 young breast cancer patients | Urgent | Preferred a more passive approach (20.7% preferred “fully passive” and 36.4% preferred fairly passive) | SG | – | |
Sidana et al. (2012) [79] | 488 young prostate cancer patients | Urgent | 52.3% preferred SDM; 45.8% an “informed decision made by myself based on information”; 2% a passive role | SDM | – | Higher education, type of procedure |
Snijders et al. (2014) [80] | 103 GI surgeons | Urgent | “most patients were offered only one treatment option and little SDM was seen” | – | SG | |
Stiggelbout & Kiebert (1997) [81] | 52 cancer patients; 48 surgical patients | Unclear | “the physician should make the decisions, but strongly consider my opinion” was selected most frequently | SG | – | Younger age, female |
Sung et al. (2010) [82] | 93 patients with pelvic floor disorder | Elective | 47% preferred a collaborative role; 44% an active role; 9% a passive role | SDM | – | |
Tyler Ellis et al. (2016) [83] | 154 newly diagnosed rectal cancer patients | Urgent | 43% of total mesorectal excision patients and 44% of local excision patients preferred SDM | SDM | – | Higher education, younger age |
Uldry et al. (2013) [84] | 253 patients undergoing elective GI surgery | Elective | 64% preferred an active role | IDM | Younger age, male, level of education | |
Vogel et al. (2008) [85] | 137 breast cancer patients | Urgent | 40.2% preferred a passive role; 30.6% an active role; 29.2% SDM | SG | – | Higher anxiety scores; multiple treatment options |
Wang et al. (2018) [86] | 154 breast cancer patients | Urgent | 55.2% preferred a collaborative role; 27.5% a passive role; 17.5% an active role | SDM | – | |
Weiner & Essis (2006) [87] | 100 spine clinic patients | Elective | “the majority of patients felt that the physician, rather than the patient, should make the basic treatment decision” | SG | – | |
Wilson et al. (2017) [88] | 157 patients undergoing major thoracic/abdominal operations | Urgent | 65.4% preferred a “patient-driven” role; 28.8% SDM; 5.8% a “surgeon-driven” role | IDM | – | |
Woltz et al. (2017) [89] | 50 patients with displaced midshaft clavicular fracture | Elective | 36% preferred SDM; 34% “autonomous” role; 30% a passive role | SDM | – | |
Ziebland et al. (2006) [90] | 43 ovarian cancer patients | Urgent | “preferred their medical team to decide on their behalf” or “‘going along with’ their doctor’s recommendation” | SG | – |
Collating and reporting the results
Variable | Studies, n(%) |
---|---|
Surgical specialtya | |
Oncology | 29 (39) |
General Surgery | 13 (18) |
Orthopedics | 10 (14) |
Urology | 9 (12) |
Gynecology | 7 (9) |
Colorectal | 6 (8) |
Thoracic | 6 (8) |
Cardiac | 5 (7) |
Plastic Surgery | 4 (5) |
Transplantation | 3 (4) |
Vascular | 3 (4) |
Neurosurgery | 2 (3) |
ENT/Otolaryngology | 1 (1) |
Ophthalmology | 1 (1) |
Cancer diagnosis | |
Yes | 50 (68) |
No | 19 (26) |
Unclear | 5 (7) |
Study methods | |
Qualitative | 18 (24) |
Quantitative | 49 (66) |
Mixed methods | 7 (9) |
Study location | |
US | 26 (35) |
Non-US | 48 (65) |
Study setting | |
Inpatient | 7 (9) |
Outpatient | 64 (86) |
Both | 3 (4) |
Type of subjects | |
Patients only | 58 (78) |
Surgeons only | 6 (8) |
Both patients and surgeons | 10 (14) |
Number of subjects | |
1–5 | 1 (1) |
6–20 | 7 (9) |
21–50 | 12 (16) |
51–100 | 11 (15) |
101–500 | 33 (45) |
> 501 | 10 (14) |
Population gender | |
Male only | 4 (5) |
Female only | 25 (34) |
Both | 45 (61) |
Clinical dilemma | |
Surgery versus non-operative management | 37 (50) |
Choice among surgical procedures | 29 (39) |
Timing of surgery | 4 (5) |
Other | 4 (5) |
Acuity of interventiona | |
Elective | 22 (30) |
Urgent | 47 (64) |
Emergent | 0 (0) |
Unclear | 7 (9) |
Surgeon preference | |
Favors surgeon-guided decision making | 4 (25) |
Favors shared decision making | 12 (75) |
Favors independent decision making | 0 (0) |
Patient preference | |
Favors surgeon-guided decision making | 26 (35) |
Favors shared decision making | 40 (54) |
Favors independent decision making | 8 (11) |