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181 The work of shared decision-making: a systematic review
  1. Victor Montori1,
  2. Fiorella Huijgens2,
  3. Ricardo Loor Torres1,
  4. Derek L Gravholt1,
  5. Arwen H Pieterse3,
  6. Larry Prokop4,
  7. Michael R Gionfriddo1,6,
  8. Nataly R Espinoza1,
  9. Ivan N Ayala1,
  10. Jennifer L Ridgeway1,6,
  11. Victor M Montori1,7,
  12. Marleen Kunneman1,3
  1. 1Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, USA
  2. 2Department of Medical Psychology, Amsterdam UMC, Amsterdam, Netherlands
  3. 3Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
  4. 4Department of Library-Public Services, Mayo Clinic, Rochester, USA
  5. 5Duquesne University School of Pharmacy, Pittsburgh, USA
  6. 6Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, USA
  7. 7Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, USA


Introduction Understanding the possible adverse effects imposed by shared decision-making (SDM) on clinicians and patients is critical for changing the treatment of SDM as a ‘box to check’ care requirement to a truly patient-centered method for making care fit. The aim of this review is to investigate whether studies that assess SDM also assess the work, workload, or burden that may be involved in carrying out SDM.

Methods We performed a citation search of all SDM measures described in Gärtner et al’s systematic review.1 We included original research published 2012–2022 about real-life patients, clinicians, and decisions about health/care that reported scores on ≥1 SDM measures that assessed the work, workload, or burden of the SDM process. All papers were screened for eligibility in duplicate. Ongoing data extraction include paper and study design characteristics, SDM measures used, and assessments of work/burden.

Results Our search yielded 3059 unique papers, of which 1350 full texts were screened, and 182 papers were eligible and have been included in the data extraction phase. Preliminary analysis (complete analyses will be finished Q1 2024) shows that the most common assessment of work/burden related to SDM was decisional conflict (≥88 papers, 48%). We will further categorize quantitative measures and qualitative mentions of SDM work/burden according to their focus (temporal, cognitive, emotional, social, logistical/financial, expectations, or other) and perspective (patient, caregiver, clinician, or other).

Discussion and Conclusion SDM is a promising method to support patients and clinicians in coproducing care plans that fit. To truly understand SDM’s potential contribution, we need to better assess, and start to consider, the possible work and burden that SDM imposes on patients, caregivers, and clinicians. Furthermore, understanding how SDM can become a burdensome task could contribute to work to make care minimally disruptive while remaining responsive to patient’s situation and goals.


  1. Gärtner FR, Bomhof-Roordink H, Smith IP, Scholl I, Stiggelbout AM, Pieterse AH. PLoS one, 2018;13(2).

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