Table 1 Taxonomy of barriers and facilitators and their definitions
Knowledge | |
|---|---|
Lack of awareness | Inability to correctly acknowledge the existence of shared decision-making (SDM) [27] |
Lack of familiarity | Inability to correctly answer questions about SDM content, as well as self-reported lack of familiarity [27] |
Forgetting | Inadvertently omitting to implement SDM [41] |
Attitudes | |
Lack of agreement with specific components of shared decision-making | |
   • Interpretation of evidence | Not believing that specific elements of SDM are supported by scientific evidence [27] |
   • Lack of applicability | |
â—‹ Characteristics of the patient | Lack of agreement with the applicability of SDM to practice population based on the characteristics of the patient [27] |
â—‹ Clinical situation | Lack of agreement with the applicability of SDM to practice population based on the clinical situation [27] |
   • Asking patient about his/her the preferred role in decision-making | Lack of agreement with a specific component of SDM such as asking patients about their preferred role in decision-making [27] |
   • Asking patient about support or undue pressure | Lack of agreement with a specific component of SDM such as asking patients about support and/or undue pressure [27] |
   • Asking about values/clarifying values | Lack of agreement with a specific component of SDM such as asking patients about values [27] |
   • Not cost-beneficial | Perception that there will be increased costs if SDM is implemented [28] |
   • Lack of confidence in the developers | Lack of confidence in the individuals who are responsible for developing or presenting SDM [27] |
Lack of agreement in general | |
   • "Too cookbook" – too rigid to be applicable | Lack of agreement with SDM because it is too artificial [27] |
   • Challenge to autonomy | Lack of agreement with SDM because it is a threat to professional autonomy [27] |
   • Biased synthesis | Perception that the authors were biased [27] |
   • Not practical | Lack of agreement with SDM because it is unclear or impractical to follow [28] |
   • Total lack of agreement with using the model (not specified why) | Lack of agreement with SDM in general (unspecified) [27] |
Lack of expectancy | |
   • Patient's outcome | Perception that performance following the use of SDM will not lead to improved patient outcome [27] |
   • Health care process | Perception that performance following the use of SDM will not lead to improved health care process [28] |
   • Feeling expectancy | Perception that performance following the use of SDM will provoke difficult feelings and/or does not take into account existing feelings [28] |
Lack of self-efficacy | Belief that one cannot perform SDM [27] |
Lack of motivation | Lack of motivation to use SDM or to change one's habits [27] |
Behaviour | |
External barriers | |
   • Factors associated with patient | |
â—‹ Preferences of patients | Perceived inability to reconcile patient preferences with the use of SDM [27] |
   • Factors associated with shared decision-making as an innovation | |
â—‹ Lack of triability | Perception that SDM cannot be experimented with on a limited basis [30] |
â—‹ Lack of compatibility: | Perception that SDM is not consistent with one's own approach [30] |
â—‹ Complexity | Perception that SDM is difficult to understand and to put into use [30] |
â—‹ Lack of observability | Lack of visibility of the results of using SDM [30] |
â—‹ Not communicable | Perception that it is not possible to create and share information with one another in order to reach a mutual understanding of SDM [30] |
â—‹ Increased uncertainty | Perception that the use of SDM will increase uncertainty (for example, lack of predictability, of structure, of information [30] |
â—‹ Not modifiable/way of doing it | Lack of flexibility in the degree to which SDM is not changeable or modifiable by a user in the process of its adoption and implementation [30] |
   • Factors associated with environmental factors | |
â—‹ Time pressure | Insufficient time to put SDM into practice [30] |
â—‹ Lack of resources | Insufficient materials or staff to put SDM into practice [28] |
â—‹ Organizational constraints | Insufficient support from the organization |
â—‹ Lack of access to services | Inadequate access to actual or alternative health care services to put SDM into practice [28] |
â—‹ Lack of reimbursement | Insufficient reimbursement for putting SDM into practice [28] |
â—‹ Perceived increase in malpractice liability | Risk of legal actions is increased if SDM is put into practice [28] |
â—‹ Sharing responsibility with Patient* | Using SDM lowers the responsibility of the health professional because it is shared with patient |