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174 Patient-reported barriers and facilitators to participation in shared decision-making a qualitative evidence synthesis
  1. Lien S Mertens1,
  2. T Kasmi1,
  3. T Bekkering2,
  4. K Hannes3,
  5. R Sars4,
  6. M Vermandere5,
  7. N Delvaux5,
  8. P Van Bostraeten1,
  9. J Jaeken1,
  10. T Van Der Weijden6,
  11. J Rademakers6,
  12. B Aertgeerts5
  1. 1Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
  2. 2Belgian Centre for Evidence-Based medicine, Leuven Belgium; JBI Belgium: A JBI Affiliated Group, Leuven, Belgium; Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
  3. 3Research Group SoMeTHin’K, Faculty of Social Science, KU Leuven, Leuven, Belgium; JBI Belgium: A JBI Affiliated Group, Leuven, Belgium
  4. 4Faculty of Health, Medicine and Life Sciences, Family Medicine; CAPHRI – Promoting Health and Personalised Care. Maastricht University, Netherlands
  5. 5Belgian Centre for Evidence-Based medicine, Leuven Belgium; Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
  6. 6Faculty of Health, Medicine and Life Sciences, Family Medicine; CAPHRI – Promoting Health and Personalised Care. Maastricht University, Netherlands

Abstract

Introduction Patients’ perspectives on shared decision-making (SDM) has mostly been limited to studies about whether or not patients prefer to share decisions with their physicians(1). A more in-depth analysis of this perspective is lacking. It seems needed to better delineate the ‘cannot’ participate patients from the definitely ‘do not want’ to participate(12), in order to reach for a more generalizable, uniform and inclusive insight in patients’ perspective on participation in SDM.

Methods A systematic search strategy was conducted using five databases, covering the areas of ‘decision-making’, ‘patient participation’, ‘patient perceptions’ and ‘study design (of patient reporting)’, from 2012 onwards. We selected articles based on a purposeful sampling strategy with the aim of finding novel trends in the field, as well as peculiarities within challenging SDM circumstances.

Results Four barriers and four facilitators were defined: a ‘lack of understandable information’ (Barrier 1), ‘one’s undervaluing of own’s capacity and expertise’ (Barrier 2), a perceived ‘lack of choice’ (Barrier 3), ‘blind trust of the doctor’ because of his ‘expert’ position (Barrier 4), ‘feeling listened to’ (Facilitator 1), ‘belief in the importance of SDM and own’s role’ (Facilitator 2), ‘being assertive’ (Facilitator 3) and ‘being supported by family, friends and peers’ (Facilitator 4).

Discussion Compared to the results of the latest review on this topic(2), most of the themes were concordant, in content as well as in prevalence. However, ‘Assertiveness’ was a newly identified element compared to the older review, and some differing attitudes according to information disclosure and decisional power were defined in particular contexts.

Conclusion(s) We did discover new and promising trends concerning patients’ role perception and the positive character of assertiveness in the process. Furthermore, our review confirmed most of the findings that had been defined in previous literature.

References

  1. Levinson W, Kao A, Kuby ATR. Not all patients want to participate in decision making. A national study of public preferences. J Gen Intern Med. 2005;20:531–5.

  2. Joseph-Williams N, Elwyn GEA. Knowledge is not power for patients: a systematic review and thematic synthesis of patient-reported barriers and facilitators to shared decision making. Patient Educ Couns. 2014;94:291–309.

  3. Frosch DL, May SG, Rendle KAS, Tietbohl CEG. Authoritarian physicians and patients’ fear of being labeled ‘difficult’ among key obstacles to shared decision making. Heal Aff. 2012;31(5):1030–8.

  4. Légaré F, St-Jacques S, Gagnon S, Njoya M, et al. Prenatal screening for down syndrome: a survey of willingness in women and family physicians to engage in shared decision-making. Prenat Diagn. 2011;31:319–26.

  5. Alsulamy N, Lee A, Thokala PAT. What influences the implementation of shared decision making: an umbrella review. Patient Educ Couns. 2020;103:2400–7.

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