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Interventions for increasing the use of shared decision making by healthcare professionals
Open accessAbstract
BACKGROUND: Shared decision making (SDM) is a process by which a healthcare choice is made by the patient, significant others, or both with one or more healthcare professionals. However, it has not yet been widely adopted in practice. This is the second update of this Cochrane review. OBJECTIVES: To determine the effectiveness of interventions for increasing the use of SDM by healthcare professionals. We considered interventions targeting patients, interventions targeting healthcare professionals, and interventions targeting both. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase and five other databases on 15 June 2017. We also searched two clinical trials registries and proceedings of relevant conferences. We checked reference lists and contacted study authors to identify additional studies. SELECTION CRITERIA: Randomized and non-randomized trials, controlled before-after studies and interrupted time series studies evaluating interventions for increasing the use of SDM in which the primary outcomes were evaluated using observer-based or patient-reported measures. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane.We used GRADE to assess the certainty of the evidence. MAIN RESULTS: We included 87 studies (45,641 patients and 3113 healthcare professionals) conducted mainly in the USA, Germany, Canada and the Netherlands. Risk of bias was high or unclear for protection against contamination, low for differences in the baseline characteristics of patients, and unclear for other domains.Forty-four studies evaluated interventions targeting patients. They included decision aids, patient activation, question prompt lists and training for patients among others and were administered alone (single intervention) or in combination (multifaceted intervention). The certainty of the evidence was very low. It is uncertain if interventions targeting patients when compared with usual care increase SDM whether measured by observation (standardized mean difference (SMD) 0.54, 95% confidence interval (CI) -0.13 to 1.22; 4 studies; N = 424) or reported by patients (SMD 0.32, 95% CI 0.16 to 0.48; 9 studies; N = 1386; risk difference (RD) -0.09, 95% CI -0.19 to 0.01; 6 studies; N = 754), reduce decision regret (SMD -0.10, 95% CI -0.39 to 0.19; 1 study; N = 212), improve physical (SMD 0.00, 95% CI -0.36 to 0.36; 1 study; N = 116) or mental health-related quality of life (QOL) (SMD 0.10, 95% CI -0.26 to 0.46; 1 study; N = 116), affect consultation length (SMD 0.10, 95% CI -0.39 to 0.58; 2 studies; N = 224) or cost (SMD 0.82, 95% CI 0.42 to 1.22; 1 study; N = 105).It is uncertain if interventions targeting patients when compared with interventions of the same type increase SDM whether measured by observation (SMD 0.88, 95% CI 0.39 to 1.37; 3 studies; N = 271) or reported by patients (SMD 0.03, 95% CI -0.18 to 0.24; 11 studies; N = 1906); (RD 0.03, 95% CI -0.02 to 0.08; 10 studies; N = 2272); affect consultation length (SMD -0.65, 95% CI -1.29 to -0.00; 1 study; N = 39) or costs. No data were reported for decision regret, physical or mental health-related QOL.Fifteen studies evaluated interventions targeting healthcare professionals. They included educational meetings, educational material, educational outreach visits and reminders among others. The certainty of evidence is very low. It is uncertain if these interventions when compared with usual care increase SDM whether measured by observation (SMD 0.70, 95% CI 0.21 to 1.19; 6 studies; N = 479) or reported by patients (SMD 0.03, 95% CI -0.15 to 0.20; 5 studies; N = 5772); (RD 0.01, 95%C: -0.03 to 0.06; 2 studies; N = 6303); reduce decision regret (SMD 0.29, 95% CI 0.07 to 0.51; 1 study; N = 326), affect consultation length (SMD 0.51, 95% CI 0.21 to 0.81; 1 study, N = 175), cost (no data available) or physical health-related QOL (SMD 0.16, 95% CI -0.05 to 0.36; 1 study; N = 359). Mental health-related QOL may slightly improve (SMD 0.28, 95% CI 0.07 to 0.49; 1 study, N = 359; low-certainty evidence).It is uncertain if interventions targeting healthcare professionals compared to interventions of the same type increase SDM whether measured by observation (SMD -0.30, 95% CI -1.19 to 0.59; 1 study; N = 20) or reported by patients (SMD 0.24, 95% CI -0.10 to 0.58; 2 studies; N = 1459) as the certainty of the evidence is very low. There was insufficient information to determine the effect on decision regret, physical or mental health-related QOL, consultation length or costs.Twenty-eight studies targeted both patients and healthcare professionals. The interventions used a combination of patient-mediated and healthcare professional directed interventions. Based on low certainty evidence, it is uncertain whether these interventions, when compared with usual care, increase SDM whether measured by observation (SMD 1.10, 95% CI 0.42 to 1.79; 6 studies; N = 1270) or reported by patients (SMD 0.13, 95% CI -0.02 to 0.28; 7 studies; N = 1479); (RD -0.01,
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“We identified six RCTs that evaluated educational interventions for critically ill patients and their families (583-588).”
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“By simulating scenarios that mirror real-life clinical decision-making processes, and through reading the multi-agent conversations, clinicians can be made aware of potential cognitive biases and how to correct them. This facilitates learning in a controlled, educational environment [25,26].”
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“Two systematic reviews and meta-analyses (501, 502) summarized the total body of evidence: they do not show a difference in mortality between patients who receive continuous (CRRT) versus intermittent hemodialysis (IHD).”
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Self-citationBerger‐Höger, B., Liethmann, K., Mühlhauser, I., Haastert, B., & Steckelberg, A. (2015) · Trials · doi:10.1186/s13063-015-0991-8 · Cited by 26
MacLachlan, E., Shepard-Perry, M., Ingo, P., Uusiku, J., Mushimba, R., Simwanza, R., Likoro, J., Brandt, L. J., Thomas, K., Kasonka, C., et al. (2015) · AIDS Care · doi:10.1080/09540121.2015.1124975 · Cited by 25
Translating research into practice: A German sickness fund supporting patient participation
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Maindal, H. T., Sandbæk, A., Kirkevold, M., & Lauritzen, T. (2011) · Scandinavian Journal of Public Health · doi:10.1177/1403494811402721 · Cited by 23
Missed opportunity? Caregiver participation in the clinical encounter. A videographic analysis
Boehmer, K. R., Egginton, J. S., Branda, M. E., Kryworuchko, J., Bodde, A. E., Montori, V. M., & LeBlanc, A. (2014) · Patient Education and Counseling · doi:10.1016/j.pec.2014.05.016 · Cited by 22
Self-citationvan Peperstraten, A. M., Hermens, R., Nelen, W. L. D. M., Stalmeier, P. F. M., Wetzels, A. M. M., Maas, P. H. M., Kremer, J. A. M., & Grol, R. P. T. M. (2009) · Patient Education and Counseling · doi:10.1016/j.pec.2009.04.007 · Cited by 22
McCusker, J., Jones, J. M., Li, M., Faria, R., Yaffe⃰, M. J., Lambert, S., Ciampi, A., Belzile, É., & de Raad, M. (2021) · Journal of Clinical Oncology · doi:10.1200/jco.20.01802 · Cited by 22
Rise, M. B., Eriksen, L., Grimstad, H., & Steinsbekk, A. (2012) · BMC Health Services Research · doi:10.1186/1472-6963-12-348 · Cited by 21
Shared Decision Making in Prostate-Specific Antigen Testing
Landrey, A. R., Matlock, D. D., Andrews, L., Bronsert, M. R., & Denberg, T. (2012) · Journal of Primary Care & Community Health · doi:10.1177/2150131912447074 · Cited by 21
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Ockhuysen-Vermey, C. F., Henneman, L., van Asperen, C. J., Oosterwijk, J. C., Menko, F. H., & Timmermans, D. R. M. (2008) · BMC Cancer · doi:10.1186/1471-2407-8-283 · Cited by 19
Can Participation in Documentation Influence Experiences of Involvement in Care Decision-Making?
Vestala, H., & Frisman, G. H. (2013) · The Open Nursing Journal · doi:10.2174/1874434620130516002 · Cited by 19
Roelands, M., Oost, P. V., Stevens, V. K., Depoorter, A., & Buysse, A. (2004) · Patient Education and Counseling · doi:10.1016/j.pec.2003.10.002 · Cited by 19
Koekkoek, B., van Meijel, B., Schene, A. H., Smit, A., Kaasenbrood, A., & Hutschemaekers, G. J. M. (2011) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2011.11.003 · Cited by 18
Kupke, J., Wicht, M. J., Stützer, H., Derman, S. H. M., Lichtenstein, N., & Noack, M. J. (2012) · European Journal Of Dental Education · doi:10.1111/eje.12002 · Cited by 16
Altshuler, L. A., Plaksin, J., Zabar, S. R., Wallach, A. B., Sawicki, C., Kundrod, S., & Kalet, A. L. (2016) · JMIR Research Protocols · doi:10.2196/resprot.5376 · Cited by 16
Translating Medical Evidence to Promote Informed Health Care Decisions
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Maindal, H. T., Carlsen, A. H., Lauritzen, T., Sandbæk, A., & Simmons, R. K. (2014) · Diabetic Medicine · doi:10.1111/dme.12440 · Cited by 13
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Omaki, E. C., Castillo, R. C., Eden, K., Davis, S., McDonald, E. M., Murtaza, U. I., & GIELEN, A. C. (2017) · Injury Prevention · doi:10.1136/injuryprev-2017-042319 · Cited by 9
Thompson, W., Farrell, B. J., Welch, V. A., Tugwell, P., & Bjerre, L. M. (2016) · Canadian Pharmacists Journal / Revue des Pharmaciens du Canada · doi:10.1177/1715163516679425 · Cited by 8
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Flagged first, then by citations
1 of the 205 references couldn’t be matched to a known paper.
Research works printed but not linked: 19
- Hermansen Kobulnicky, 2002, The behavioral impact of teaching patients to monitor side effects of chemotherapy: an intervention study
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Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021.
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., et al. (2021) · Critical Care Medicine · doi:10.1097/ccm.0000000000005337 · Cited by 2,935
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2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy
Ommen, S. R., Mital, S., Burke, M. A., Day, S. M., Deswal, A., Elliott, P., Evanovich, L. L., Hung, J., Joglar, J. A., Kantor, P., et al. (2020) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2020.08.045 · Cited by 643
2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy
Ommen, S. R., Mital, S. R., Burke, M. A., Day, S. M., Deswal, A. M., Elliot, P. M., Evanovich, L. L., Hung, J., Joglar, J. A., Kantor, P. F., et al. (2020) · Circulation · doi:10.1161/cir.0000000000000937 · Cited by 641
2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy
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Metadata
- Authors
- Légaré, F., Adekpedjou, R., Stacey, D., Turcotte, S., Kryworuchko, J., Graham, I. D., Lyddiatt, A., Politi, M. C., Thomson, R., Elwyn, G., & Donner-Banzhoff, N.
- Affiliations
- Université Laval (CA)
- University of Ottawa (CA)
- Hôpital Saint-François d'Assise (CA)
- University of British Columbia (CA)
- No affiliation; 28 Greenwood Road Ingersoll ON Canada N5C 3N1
- Washington University in St. Louis (US)
- Newcastle University (GB)
- Cochrane (GB)
- University of Marburg; Department of Family Medicine / General Practice; Karl-von-Frisch-Str. 4 Marburg Germany D-35039
- ORCID
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- Wiley
- Published
- 2018-07-19
- Volume
- 2018
- Issue
- 7
- Pages
- CD006732-CD006732
- ISSN
- 1361-6137 (ISSN-L)
- 1465-1858
- PMC
- PMC6513543
- OpenAlex
- W2884603128
- Cited by
- 698
- References
- 205
- Citations by year
- 2026: 34 · 2025: 120 · 2024: 124 · 2023: 94 · 2022: 99 · 2021: 95 · 2020: 67 · 2019: 54 · 2018: 8
- FWCI
- 10.20
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Cochrane Database of Systematic Reviews (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Keywords
- shared decision-making, healthcare workers, intervention, decision aids, patient activation, patient education, patient-provider communication, decision regret, patient satisfaction, patient-reported outcomes, patient-centered care, implementation of shared decision making, multicomponent intervention, contamination risk, risk of bias, quality of evidence, patient engagement, patient participation
- MeSH terms
- Decision Making, Decision Support Techniques, Health Personnel, Humans, Patient Education as Topic, Patient Participation, Randomized Controlled Trials as Topic
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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