What Influences the Implementation of Shared Decision Making: An Umbrella Review

Abstract

Objective: To provide a cogent summation of the evidence base of the key barriers and facilitators to implementing shared decision making (SDM).

Methods: An umbrella review of existing reviews on SDM was adopted. Databases were searched from 1997 to December 2018. Studies were included if they performed a review of barriers and facilitators to SDM.

Results: 7 eligible reviews were identified. The five themes identified were: patient factors, professional factors, environmental factors, relationship factors, and factors related to information provision. Lack of time was the main factor hindering the implementation of SDM. Encouragement and motivation of providers to use SDM was a significant enabler of SDM implementation.

Conclusions: The provision of time and resources are insufficient if not accompanied by efforts to support and motivate providers to use SDM.

Practice implications: Healthcare providers need to be educated on the importance of building a relationship with their patients. To enhance this relationship, physicians may need to improve their interaction skills. They need to be curious and explore their patients' preferences, listen to them and respect their opinions, explain options and outcomes, and encourage them to participate in the decision making.

Keywords: Shared decision making; barriers/facilitators; implementation; patient-centred care; umbrella review.