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Patients’ Perceptions of Sharing in Decisions

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  • France Légaré
  • Stéphane Turcotte
  • Dawn Stacey
  • Stéphane Ratté
  • Jennifer Kryworuchko
  • Ian Graham

Abstract

Background: Shared decision making is the process in which a healthcare choice is made jointly by the health professional and the patient. Little is known about what patients view as effective or ineffective strategies to implement shared decision making in routine clinical practice. Objective: This systematic review evaluates the effectiveness of interventions to improve health professionals’ adoption of shared decision making in routine clinical practice, as seen by patients. Data Sources: We searched electronic databases (PubMed, the Cochrane Library, EMBASE, CINAHL, and PsycINFO) from their inception to mid-March 2009. We found additional material by reviewing the reference lists of the studies found in the databases; systematic reviews of studies on shared decision making; the proceedings of various editions of the International Shared Decision Making Conference; and the transcripts of the Society for Medical Decision Making’s meetings. Study Selection: In our study selection, we included randomized controlled trials, controlled clinical trials, controlled before-and-after studies, and interrupted time series analyses in which patients evaluated interventions to improve health professionals’ adoption of shared decision making. The interventions in question consisted of the distribution of printed educational material; educational meetings; audit and feedback; reminders; and patient-mediated initiatives (e.g. patient decision aids). Study Appraisal: Two reviewers independently screened the studies and extracted data. Statistical analyses considered categorical and continuous process measures. We computed the standardized effect size for each outcome at the 95% confidence interval. The primary outcome of interest was health professionals’ adoption of shared decision making as reported by patients in a self-administered questionnaire. Results: Of the 6764 search results, 21 studies reported 35 relevant comparisons. Overall, the quality of the studies ranged from 0% to 83%. Only three of the 21 studies reported a clinically significant effect for the primary outcome that favored the intervention. The first study compared an educational meeting and a patient-mediated intervention with another patient-mediated intervention (median improvement of 74%). The second compared an educational meeting, a patient-mediated intervention, and audit and feedback with an educational meeting on an alternative topic (improvement of 227%). The third compared an educational meeting and a patient-mediated intervention with usual care (p=0.003). All three studies were limited to the patient-physician dyad. Limitations: To reduce bias, future studies should improve methods and reporting, and should analyze costs and benefits, including those associated with training of health professionals. Conclusions: Multifaceted interventions that include educating health professionals about sharing decisions with patients and patient-mediated interventions, such as patient decision aids, appear promising for improving health professionals’ adoption of shared decision making in routine clinical practice as seen by patients. Copyright Adis Data Information BV 2012

Suggested Citation

  • France Légaré & Stéphane Turcotte & Dawn Stacey & Stéphane Ratté & Jennifer Kryworuchko & Ian Graham, 2012. "Patients’ Perceptions of Sharing in Decisions," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 5(1), pages 1-19, March.
  • Handle: RePEc:spr:patien:v:5:y:2012:i:1:p:1-19
    DOI: 10.2165/11592180-000000000-00000
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    References listed on IDEAS

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    1. Annette M. O'Connor & Dawn Stacey & Michael J. Barry & Nananda F. Col & Karen B. Eden & Vikki Entwistle & Valerie Fiset & Margaret Holmes-Rovner & Sara Khangura & Hilary Llewellyn-Thomas & David R. Ro, 2007. "Do Patient Decision Aids Meet Effectiveness Criteria of the International Patient Decision Aid Standards Collaboration? A Systematic Review and Meta-analysis," Medical Decision Making, , vol. 27(5), pages 554-574, September.
    2. Charles, Cathy & Gafni, Amiram & Whelan, Tim, 1997. "Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango)," Social Science & Medicine, Elsevier, vol. 44(5), pages 681-692, March.
    3. James G. Dolan & Susan Frisina, 2002. "Randomized Controlled Trial of a Patient Decision Aid for Colorectal Cancer Screening," Medical Decision Making, , vol. 22(2), pages 125-139, April.
    4. Clarence H. Braddock, 2010. "The Emerging Importance and Relevance of Shared Decision Making to Clinical Practice," Medical Decision Making, , vol. 30(5_suppl), pages 5-7, September.
    5. Anne M. Stiggelbout & Albert C. Molewijk & Wilma Otten & J. Hajo Van Bockel & Cornelis M. A. Bruijninckx & Ilse Van der Salm & Job Kievit, 2008. "The Impact of Individualized Evidence-Based Decision Support on Aneurysm Patients' Decision Making, Ideals of Autonomy, and Quality of Life," Medical Decision Making, , vol. 28(5), pages 751-762, September.
    6. Charles, Cathy & Gafni, Amiram & Whelan, Tim, 1999. "Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model," Social Science & Medicine, Elsevier, vol. 49(5), pages 651-661, September.
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