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abstract
Objectives
To systematically
review patient-reported barriers and facilitators to shared decision
making (SDM) and develop a taxonomy of patient-reported barriers.
Methods
Systematic
review and thematic synthesis. Study findings/results for each included
paper were extracted verbatim and entered into qualitative software for
inductive analysis.
Results
Electronic
and follow-up searches yielded 2956 unique references; 289 full-text
articles were retrieved, of which 45 articles from 44 unique studies met
inclusion criteria. Key descriptive themes were grouped under two broad
analytical themes: how the healthcare system is organized (4
descriptive themes) and what happens during the decision-making
interaction (4 descriptive themes, 10 sub-themes). Predominant emergent
themes related to patients’ knowledge and the power imbalance in the
doctor-patient relationship. Patients need knowledge and power to
participate in SDM–knowledge alone is insufficient and power is more
difficult to attain.
Conclusions
Many
barriers are potentially modifiable, and can be addressed by
attitudinal changes at the levels of patient, clinician/healthcare team,
and the organization. The results support the view that many patients
currently can’t participate in SDM, rather than they won’t participate
because they do not want to.
Practice implications
Future
implementation efforts should address patient-reported factors together
with known clinician-reported barriers and the wider organizational
context.
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