Original Title: Barreras y facilitadores para la implementación de la toma de decisiones compartidas

Authors' objectives: This review aims to provide knowledge scientifically valid and of great value to patients and healthcare professionals on the barriers and facilitators influencing the implementation of shared decision making in routine clinical practice, existing or not a DA (decision making).

Authors' results and conclusions: RESULTS: A total of 11454 references were considered, and 8553 after the elimination of duplicates; 69 were selected for detailed assessment. Nine articles were eventually included: four with quantitative methods (Chambers, 2007; Graham, 2007; Politi, 2009; Brackett, 2010), four with qualitative method (Thistlethwaite, 2007; Silvia, 2008; Watson, 2008; Rees, 2009) and one used a mixed method (Harrison, 2009). Studies were published in English, and the origin countries were Canada, United States, United Kingdom and Australia. Participants from studies included were composed mostly of health professional (primary care and specialists physicians, nurses, elath visitors, and health managers). The sample of one study was composed of patients and health professionals. Regarding to barriers, the most often barriers identified were "lack of applicability of the SDM based on patient characteristics", the "time pressure" that occurs in clinical practice, and factors related to the SDM as innovation, in particular to the "complexity" which could mean the SDM to understand and implement. Similarly, barriers were factors associated with the Health System and/or Services, in particular, associated with the "lack of resources", "lack of familiarity", "lack of applicability based on the clinical situation", "lack of expectations based on the health care process", and "patient preferences". In relation to the facilitators, which was identified more often belongs to the cognitive area, in particular, to the expectations regarding the "process of health care." The next most commonly cited facilitators pertain to the behavioral area, within the group of external facilitators: facilitators related to the "compatibility" within the "factors related to the SDM as an innovation", and facilitators related to "saving of time" that are grouped under the subcategory "factors associated with health system/services". CONCLUSIONS: The results obtained in this review are in line with the Lègarè et al. (2008) work, especially those related to patient characteristics and the lack of time as major barriers to the SDM implementation. Health professionals show reluctance towards widespread SDM implementation not take into account the characteristics of the patient. Moreover, as to the constraints of time available for some professionals, this is a widespread problem in health care, especially in public services. In this sense, it is necessary to investigate to what extent the implementation SDM or DA increases the time of patient care versus traditional care, because the evidence is not robust. In addition, future research should be made to answer what type of patient would benefit from SDM, and erroneous attributions that health professional make about patients and what interventions could be modified.

Project Status: Completed

Year Published: 2010

URL for published report: https://sescs.es/barreras-y-facilitadores-para-la-implementacion-de-la-toma-de-decisiones-compartidas/

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Spain

Organisation Name: Canary Health Service

Contact Address: Dirección del Servicio. Servicio Canario de la Salud, Camino Candelaria 44, 1ª planta, 38109 El Rosario, Santa Cruz de Tenerife

Contact Name: sescs@sescs.es

Contact Email: sescs@sescs.es