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Meta-Analysis
. 2024 Apr;38(4):406-422.
doi: 10.1177/02692163241238384. Epub 2024 Mar 13.

Shared decision-making in palliative cancer care: A systematic review and metasynthesis

Jannicke Rabben  1 , Bella Vivat  2 , Mariann Fossum  1 , Gudrun Elin Rohde  1   2   3
Affiliations
Meta-Analysis

Shared decision-making in palliative cancer care: A systematic review and metasynthesis

Jannicke Rabben et al. Palliat Med. 2024 Apr.

Abstract

Background: Shared decision-making is a key element of person-centred care and promoted as the favoured model in preference-sensitive decision-making. Limitations to implementation have been observed, and barriers and limitations, both generally and in the palliative setting, have been highlighted. More knowledge about the process of shared decision-making in palliative cancer care would assist in addressing these limitations.

Aim: To identify and synthesise qualitative data on how people with cancer, informal carers and healthcare professionals experience and perceive shared decision-making in palliative cancer care.

Design: A systematic review and metasynthesis of qualitative studies. We analysed data using inductive thematic analysis.

Data sources: We searched five electronic databases (MEDLINE, EMBASE, PsycINFO, CINAHL and Scopus) from inception until June 2023, supplemented by backward searches.

Results: We identified and included 23 studies, reported in 26 papers. Our analysis produced four analytical themes; (1) Overwhelming situation of 'no choice', (2) Processes vary depending on the timings and nature of the decisions involved, (3) Patient-physician dyad is central to decision-making, with surrounding support and (4) Level of involvement depends on interactions between individuals and systems.

Conclusion: Shared decision-making in palliative cancer care is a complex process of many decisions in a challenging, multifaceted and evolving situation where equipoise and choice are limited. Implications for practice: Implementing shared decision-making in clinical practice requires (1) clarifying conceptual confusion, (2) including members of the interprofessional team in the shared decision-making process and (3) adapting the approach to the ambiguous, existential situations which arise in palliative cancer care.

Keywords: Decision making; neoplasms; palliative care; qualitative research; shared decision making; systematic review.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Screening and inclusion flow chart.
Figure 2.
Figure 2.
Visualisation of proportion of contribution of each participant group to each analytical theme.
See this image and copyright information in PMC

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References

    1. Bravo P, Härter M, McCaffery K, et al.. Editorial: 20 years after the start of international Shared Decision-Making activities: Is it time to celebrate? Probably. . . Z Evid, Fortbild Qual Gesundhwes 2022; 171: 1–4. - PubMed
    1. Barry MJ, Edgman-Levitan S. Shared decision making—the pinnacle of patient-centered care. N Engl J Med 2012; 366: 780–781. - PubMed
    1. Stiggelbout AM, Pieterse AH, De Haes JC. Shared decision making: concepts, evidence, and practice. Patient Educ Couns 2015; 98: 1172–1179. - PubMed
    1. Elwyn G, Laitner S, Coulter A, et al.. Implementing shared decision making in the NHS. BMJ 2010; 341: c5146. - PubMed
    1. Bomhof-Roordink H, Gärtner FR, Stiggelbout AM, et al.. Key components of shared decision making models: a systematic review. BMJ Open 2019; 9: e031763. - PMC - PubMed