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Where Is the Evidence? A Systematic Review of Shared Decision Making and Patient Outcomes
Author(s):
L. Aubree Shay
1
,
2
,
Jennifer Elston Lafata
1
,
2
Publication date
Created:
November 05 2014
Publication date
(Electronic):
October 28 2014
Journal:
Medical Decision Making
Publisher:
SAGE Publications
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Abstract
Despite widespread advocacy for shared decision making (SDM), the empirical evidence regarding its effectiveness to improve patient outcomes has not been systematically reviewed. The purpose of this study was to systematically review the empirical evidence linking patient outcomes and SDM, when the decision-making process has been explicitly measured, and to identify under what measurement perspectives SDM is associated with which types of patient outcomes (affective-cognitive, behavioral, and health). PubMed (through December 2012) and hand search of article bibliographies. Studies were included if they empirically 1) measured SDM in the context of a patient-clinician interaction and 2) evaluated the relationship between SDM and at least 1 patient outcome. Study results were categorized by SDM measurement perspective (patient-reported, clinician-reported, or observer-rated) and outcome type (affective-cognitive, behavioral, or health). Thirty-nine studies met inclusion criteria. Thirty-three used patient-reported measures of SDM, 6 used observer-rated measures, and 2 used clinician-reported measures. Ninety-seven unique patient outcomes were assessed; 51% affective-cognitive, 28% behavioral, and 21% health. Only 43% of assessments (n = 42) found a significant and positive relationship between SDM and the patient outcome. This proportion varied by SDM measurement perspective and outcome category. It was found that 52% of outcomes assessed with patient-reported SDM were significant and positive, compared with 21% with observer-rated and 0% with clinician-reported SDM. Regardless of measurement perspective, SDM was most likely to be associated with affective-cognitive patient outcomes (54%), compared with 37% of behavioral and 25% of health outcomes. The relatively small number of studies precludes meta-analysis. Because the study inclusion and exclusion criteria required both an empirical measure of SDM and an assessment of the association between that measure and a patient outcome, most included studies were observational in design. SDM, when perceived by patients as occurring, tends to result in improved affective-cognitive outcomes. Evidence is lacking for the association between empirical measures of SDM and patient behavioral and health outcomes. © The Author(s) 2014.
Related collections
Thermal Imaging in Social Decision Making
Author and article information
Journal
Title:
Medical Decision Making
Abbreviated Title:
Med Decis Making
Publisher:
SAGE Publications
ISSN (Print):
0272-989X
ISSN (Electronic):
1552-681X
Publication date Created:
November 05 2014
Publication date Created:
January 2015
Publication date (Electronic):
October 28 2014
Publication date (Print):
January 2015
Volume
: 35
Issue
: 1
Pages
: 114-131
Affiliations
[
1
]
University of Texas School of Public Health, Center for Health Promotions and Research, San Antonio, TX (LAS)
[
2
]
Virginia Commonwealth University, Massey Cancer Center and Department of Social and Behavioral Health, Richmond, VA (JEL)
Article
DOI:
10.1177/0272989X14551638
PMC ID:
4270851
PubMed ID:
25351843
SO-VID:
c01e2602-2c86-4815-aa9c-a8f5560a91bb
Copyright ©
© 2015
License:
http://journals.sagepub.com/page/policies/text-and-data-mining-license
History
Data availability:
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