Background: Shared 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.
Objective: To synthesize the best available evidence on internal and external influences on shared decision-making for adult patients and healthcare providers.
Inclusion criteria: Types of participants
Adult patients and healthcare providers who are involved in a shared decision-making process.
Phenomena of interest
Internal and external influences on shared decision-making.
Types of studies
Qualitative studies, including designs such as phenomenology, grounded theory, ethnography, action research, and qualitative descriptive.
Search strategy: A three-step search strategy was used to identify published and unpublished English language qualitative research studies though November 2012.
Methodological quality: Two independent reviewers, using the Qualitative Assessment and Review Instrument from the Joanna Briggs Institute, assessed retrieved papers for methodological quality.
Data collection: Data were extracted using the Joanna Briggs Institute's Qualitative Assessment and Review Instrument data extraction tool.
Data synthesis: Data were synthesized using the Joanna Briggs Institute approach to meta-synthesis by meta-aggregation using the Qualitative Assessment and Review Instrument software package.
Results: Eight 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.
Conclusions: Patient-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.