Barriers and facilitators to shared decision-making in hospitals from policy to practice: a systematic review
Abstract Background Involving patients in their healthcare using shared decision-making (SDM) is promoted through policy and research, yet its implementation in routine practice remains slow. Research into SDM has stemmed from primary and secondary care contexts, and research into the implementation...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-07-01
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| Series: | Implementation Science |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13012-021-01142-y |
| _version_ | 1818909267958169600 |
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| author | Alex Waddell Alyse Lennox Gerri Spassova Peter Bragge |
| author_facet | Alex Waddell Alyse Lennox Gerri Spassova Peter Bragge |
| author_sort | Alex Waddell |
| collection | DOAJ |
| description | Abstract Background Involving patients in their healthcare using shared decision-making (SDM) is promoted through policy and research, yet its implementation in routine practice remains slow. Research into SDM has stemmed from primary and secondary care contexts, and research into the implementation of SDM in tertiary care settings has not been systematically reviewed. Furthermore, perspectives on SDM beyond those of patients and their treating clinicians may add insights into the implementation of SDM. This systematic review aimed to review literature exploring barriers and facilitators to implementing SDM in hospital settings from multiple stakeholder perspectives. Methods The search strategy focused on peer-reviewed qualitative studies with the primary aim of identifying barriers and facilitators to implementing SDM in hospital (tertiary care) settings. Studies from the perspective of patients, clinicians, health service administrators, and decision makers, government policy makers, and other stakeholders (for example researchers) were eligible for inclusion. Reported qualitative results were mapped to the Theoretical Domains Framework (TDF) to identify behavioural barriers and facilitators to SDM. Results Titles and abstracts of 8724 articles were screened and 520 were reviewed in full text. Fourteen articles met inclusion criteria. Most studies (n = 12) were conducted in the last four years; only four reported perspectives in addition to the patient-clinician dyad. In mapping results to the TDF, the dominant themes were Environmental Context and Resources, Social/Professional Role and Identity, Knowledge and Skills, and Beliefs about Capabilities. A wide range of barriers and facilitators across individual, organisational, and system levels were reported. Barriers specific to the hospital setting included noisy and busy ward environments and a lack of private spaces in which to conduct SDM conversations. Conclusions SDM implementation research in hospital settings appears to be a young field. Future research should build on studies examining perspectives beyond the clinician-patient dyad and further consider the role of organisational- and system-level factors. Organisations wishing to implement SDM in hospital settings should also consider factors specific to tertiary care settings in addition to addressing their organisational and individual SDM needs. Trial Registration The protocol for the review is registered on the Open Science Framework and can be found at https://osf.io/da645/ , DOI https://doi.org/10.17605/OSF.IO/DA645 . |
| first_indexed | 2024-12-19T22:24:12Z |
| format | Article |
| id | doaj.art-82b43a6473854e0ca5f8c65a5a6c7f6f |
| institution | Directory Open Access Journal |
| issn | 1748-5908 |
| language | English |
| last_indexed | 2024-12-19T22:24:12Z |
| publishDate | 2021-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science |
| spelling | doaj.art-82b43a6473854e0ca5f8c65a5a6c7f6f2022-12-21T20:03:34ZengBMCImplementation Science1748-59082021-07-0116112310.1186/s13012-021-01142-yBarriers and facilitators to shared decision-making in hospitals from policy to practice: a systematic reviewAlex Waddell0Alyse Lennox1Gerri Spassova2Peter Bragge3Monash Sustainable Development Institute, Monash UniversityMonash Sustainable Development Institute, Monash UniversityDepartment of Marketing, Monash Business SchoolMonash Sustainable Development Institute, Monash UniversityAbstract Background Involving patients in their healthcare using shared decision-making (SDM) is promoted through policy and research, yet its implementation in routine practice remains slow. Research into SDM has stemmed from primary and secondary care contexts, and research into the implementation of SDM in tertiary care settings has not been systematically reviewed. Furthermore, perspectives on SDM beyond those of patients and their treating clinicians may add insights into the implementation of SDM. This systematic review aimed to review literature exploring barriers and facilitators to implementing SDM in hospital settings from multiple stakeholder perspectives. Methods The search strategy focused on peer-reviewed qualitative studies with the primary aim of identifying barriers and facilitators to implementing SDM in hospital (tertiary care) settings. Studies from the perspective of patients, clinicians, health service administrators, and decision makers, government policy makers, and other stakeholders (for example researchers) were eligible for inclusion. Reported qualitative results were mapped to the Theoretical Domains Framework (TDF) to identify behavioural barriers and facilitators to SDM. Results Titles and abstracts of 8724 articles were screened and 520 were reviewed in full text. Fourteen articles met inclusion criteria. Most studies (n = 12) were conducted in the last four years; only four reported perspectives in addition to the patient-clinician dyad. In mapping results to the TDF, the dominant themes were Environmental Context and Resources, Social/Professional Role and Identity, Knowledge and Skills, and Beliefs about Capabilities. A wide range of barriers and facilitators across individual, organisational, and system levels were reported. Barriers specific to the hospital setting included noisy and busy ward environments and a lack of private spaces in which to conduct SDM conversations. Conclusions SDM implementation research in hospital settings appears to be a young field. Future research should build on studies examining perspectives beyond the clinician-patient dyad and further consider the role of organisational- and system-level factors. Organisations wishing to implement SDM in hospital settings should also consider factors specific to tertiary care settings in addition to addressing their organisational and individual SDM needs. Trial Registration The protocol for the review is registered on the Open Science Framework and can be found at https://osf.io/da645/ , DOI https://doi.org/10.17605/OSF.IO/DA645 .https://doi.org/10.1186/s13012-021-01142-yShared decision-makingImplementationHospital careBarriers and facilitatorsTheoretical Domains Framework |
| spellingShingle | Alex Waddell Alyse Lennox Gerri Spassova Peter Bragge Barriers and facilitators to shared decision-making in hospitals from policy to practice: a systematic review Implementation Science Shared decision-making Implementation Hospital care Barriers and facilitators Theoretical Domains Framework |
| title | Barriers and facilitators to shared decision-making in hospitals from policy to practice: a systematic review |
| title_full | Barriers and facilitators to shared decision-making in hospitals from policy to practice: a systematic review |
| title_fullStr | Barriers and facilitators to shared decision-making in hospitals from policy to practice: a systematic review |
| title_full_unstemmed | Barriers and facilitators to shared decision-making in hospitals from policy to practice: a systematic review |
| title_short | Barriers and facilitators to shared decision-making in hospitals from policy to practice: a systematic review |
| title_sort | barriers and facilitators to shared decision making in hospitals from policy to practice a systematic review |
| topic | Shared decision-making Implementation Hospital care Barriers and facilitators Theoretical Domains Framework |
| url | https://doi.org/10.1186/s13012-021-01142-y |
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