Skip to main content

Table 1 Taxonomy of barriers and facilitators and their definitions

From: Barriers and facilitators to implementing shared decision-making in clinical practice: a systematic review of health professionals' perceptions

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  
Characteristics of the patient Lack of agreement with the applicability of SDM to practice population based on the characteristics of the patient [27]
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
Preferences of patients Perceived inability to reconcile patient preferences with the use of SDM [27]
   • Factors associated with shared decision-making as an innovation
Lack of triability Perception that SDM cannot be experimented with on a limited basis [30]
Lack of compatibility: Perception that SDM is not consistent with one's own approach [30]
Complexity Perception that SDM is difficult to understand and to put into use [30]
Lack of observability Lack of visibility of the results of using SDM [30]
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]
Increased uncertainty Perception that the use of SDM will increase uncertainty (for example, lack of predictability, of structure, of information [30]
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
Time pressure Insufficient time to put SDM into practice [30]
Lack of resources Insufficient materials or staff to put SDM into practice [28]
Organizational constraints Insufficient support from the organization
Lack of access to services Inadequate access to actual or alternative health care services to put SDM into practice [28]
Lack of reimbursement Insufficient reimbursement for putting SDM into practice [28]
Perceived increase in malpractice liability Risk of legal actions is increased if SDM is put into practice [28]
Sharing responsibility with Patient* Using SDM lowers the responsibility of the health professional because it is shared with patient
  1. * Only for the facilitator assessment taxonomy