To systematically review patient-reported barriers and facilitators to shared decision
making (SDM) and develop a taxonomy of patient-reported barriers.
Systematic review and thematic synthesis. Study findings/results for each included
paper were extracted verbatim and entered into qualitative software for inductive
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.
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.
Future implementation efforts should address patient-reported factors together with
known clinician-reported barriers and the wider organizational context.
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