Article Text

Download PDFPDF
270 To which extent do general practitioners involve patients in the decision-making process? A systematic review of studies that use the option instrument
  1. Dirk T Ubbink1,2,
  2. Steyn Heuvelsland2,
  3. Fadi Shamoun2
  1. 1Department of Surgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
  2. 2University of Amsterdam, Amsterdam, The Netherlands


Introduction Shared Decision Making (SDM) is considered the crux of patient-centred care, particularly in the primary healthcare setting, where a wide range of medical decisions are made. A 2015 systematic review showed that the level of SDM in various healthcare settings was relatively low,1 based on the Observing Patient Involvement in Decision Making (OPTION) instrument, designed to objectively assess SDM-levels. We systematically reviewed studies, including those in the previous review, that assessed to which extent General Practitioners (GPs) involve patients in the decision-making process.

Methods Literature searches were conducted in three digital databases, till November 2023. Studies were included if they were comparative, focused on primary healthcare, and used the OPTION- instrument. Study selection, risk of bias assessment, and data extraction using a predefined list of variables, were conducted by two investigators independently. Discrepancies were discussed with a third investigator. PROSPERO registration-ID: CRD42023475419.

Results From the initially 447 articles harvested, 26 studies were retained, which were published between 2003 and 2022. Mean age of the GPs was 45.5 (range 33–53) years. Some 1,133 recordings of consultations with patients with a diversity of disorders were included. Reported baseline (5- and 12- item) OPTION-scores varied between 7.8 and 29.4 on a 0–100-point scale, with a mean of 19.7. After an SDM-intervention OPTION-scores increased, ranging from 24.5 to 38.5.

Discussion The overall level of SDM among GPs is still relatively low and has not improved measurably during the last ten years since the review by Couët et al.1 SDM-promoting interventions do seem to increase the level of patient involvement.

Conclusion The results of this systematic review indicate that more education and tools for GPs and patients are needed to foster SDM in primary care.


  1. Couët N, Desroches S, Robitaille H, Vaillancourt H, Leblanc A, Turcotte S, Elwyn G, Légaré F. Health Expect. 2015;18(4):542–61.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.