A qualitative systematic review of internal and external influences on shared decision-making in all health care settings

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Executive summaryBackgroundShared decision-making is a process that patients and healthcare providers actively engage in. The aim of this process is for patients to have a participatory role in the shared decisions pertaining to their care. There are many internal and external influences that may encourage, support, and facilitate the shared decision-making process. These influences are intervening variables that may foster shared decision-making in practice.ObjectiveTo synthesize the best available evidence on internal and external influences on shared decision-making for adult patients and healthcare providers.Inclusion criteriaTypes of participantsAdult patients and healthcare providers who are involved in a shared decision-making process.Phenomena of interestInternal and external influences on shared decision-making.Types of studiesQualitative studies, including designs such as phenomenology, grounded theory, ethnography, action research, and qualitative descriptive.Search strategyA three-step search strategy was used to identify published and unpublished English language qualitative research studies though November 2012.Methodological qualityTwo independent reviewers, using the Qualitative Assessment and Review Instrument from the Joanna Briggs Institute, assessed retrieved papers for methodological quality.Data collectionData were extracted using the Joanna Briggs Institute's Qualitative Assessment and Review Instrument data extraction tool.Data synthesisData were synthesized using the Joanna Briggs Institute approach to meta-synthesis by meta-aggregation using the Qualitative Assessment and Review Instrument software package.ResultsEight studies were included in this review. From these studies, 61 study findings with a credibility assessment of unequivocal or credible were subsequently aggregated into 11 categories on the basis of similarity of meaning. These categories yielded three synthesized findings of influences on shared decision-making: Patient-centered care, Bridging the knowledge gap, and Dimensions of decision-making.ConclusionsPatient-centered care involves the development of a relationship based in trust and facilitated by communication between the patient and the healthcare provider. Bridging the knowledge gap takes place as the healthcare provider and the patient work in a partnership to gather information to identify the specific educational needs of each patient, while identifying and addressing barriers. Decision-making may take shape and form in varying dimensions from active participation and sharing to one where the healthcare provider assumes a more paternalistic approach or the patient assumes an autonomous role. Aspects of patient-centered care where a trusting, compassionate relationship is forged between patient and provider have the potential to both facilitate and support the achievement of a shared decision.

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