Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Jan;35(1):114-31.
doi: 10.1177/0272989X14551638. Epub 2014 Oct 28.

Where is the evidence? A systematic review of shared decision making and patient outcomes

L Aubree Shay  1 , Jennifer Elston Lafata  2
Affiliations

Where is the evidence? A systematic review of shared decision making and patient outcomes

L Aubree Shay et al. Med Decis Making. 2015 Jan.

Abstract

Background: 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).

Data sources: PubMed (through December 2012) and hand search of article bibliographies.

Study selection: 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.

Data extraction: Study results were categorized by SDM measurement perspective (patient-reported, clinician-reported, or observer-rated) and outcome type (affective-cognitive, behavioral, or health).

Data synthesis: 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.

Limitations: 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.

Conclusions: 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.

Keywords: medical decision making; patient outcomes; shared decision making; systematic review.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest:The authors have no conflicts of interest.

Figures

Figure 1
Figure 1
Conceptual framework linking SDM to patient outcomes
Figure 2
Figure 2
Categorization framework of patient outcome categories by SDM measurement type
Figure 3
Figure 3
Search strategy and selection results
See this image and copyright information in PMC

References

    1. Weston WW. Informed and shared decision-making: the crux of patient-centred care. Canadian Medical Association journal. 2001;165(4):438–439. - PMC - PubMed
    1. Godolphin W. The role of risk communication in shared decision making. BMJ. 2003;327(7417):692–693. - PMC - PubMed
    1. Research PsCftSoEPiMaBaB. Making health care decisions. Washington DC: 1982.
    1. Berwick DM. A user's manual for the IOM's 'Quality Chasm' report. Health Aff (Millwood) 2002;21(3):80–90. - PubMed
    1. Sheridan S, Harris R, Woolf S. Shared decision making about screening and chemoprevention. a suggested approach from the U.S Preventive Services Task Force. American Journal of Preventive Medicine. 2004;26(1):56–66. - PubMed

Publication types