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Table 3 Perceived barriers and facilitators to implementation of shared decision-making in clinical practice

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

Factor as a barrier/facilitator Barriers (number of studies in which this factor was identified as a barrier) [reference number] Facilitators (number of studies in which this factor was identified as a facilitator) [reference number]
Knowledge
Lack of awareness/awareness 0 0
Lack of familiarity/familiarity 5 [29, 37, 39, 44, 49] 0
Forgetting 1 [41] Not applicable
Attitude
Lack of agreement with specific components of shared decision-making/agreement with specific components of shared decision-making
   • Interpretation of evidence 1 [29]  
   • Lack of applicability/applicability   
Characteristics of the patient 12 [21, 29, 34, 37, 41, 43, 47-49, 53-55, 59] 4 [29, 35, 51, 54, 55]
Clinical situation 12 [11, 29, 34, 36-38, 47-49, 53-55, 59] 3 [37, 46, 51]
   • Asking patient about his/her preferred role in decision-making 7 [11, 38, 40, 42, 43, 50, 59] 2 [42, 50]
   • Asking patient about support or undue pressure 0 1 [34]
   • Asking about values/clarifying values 0 0
   • Not cost-beneficial/Cost-beneficial 3 [21, 29, 45] 1 [42]
   • Lack of confidence in the developers/Confidence in the developers 0 1 [29]
Lack of agreement in general/Agreement in general
   • "Too cookbook" – too rigid to be applicable 2 [29, 48] 0
   • Challenge to autonomy 1 [11] 0
   • Biased synthesis 1 [29] 0
   • Not practical/Practical 2 [29, 54, 55] 6 [29, 33, 41, 54-57]
   • Total lack of agreement with using the model (not specified why) 2 [47, 50] 0
Lack of expectancy/expectancy
   • Patient's outcome 1 [33] 10 [33, 34, 37, 42, 46, 50-52, 54-56]
   • Process expectancy 1 [56] 11 [11, 29, 33, 34, 36, 41, 42, 50, 51, 54, 55, 57]
   • Feeling expectancy 0 1 [34]
Lack of self-efficacy/Self-efficacy 6 [21, 34, 37, 48, 50, 53] 0
Lack of motivation/Motivation 4 [21, 37, 51, 52] 15 [33, 35, 36, 38, 39, 41-44, 47, 49, 51, 52, 54, 55, 57, 58]
Behaviour
External factors
   • Factors associated with patient   
Preferences of patients 9 [21, 39, 41, 42, 45, 47, 48, 52, 54, 55] 4 [34, 39, 42, 52]
   • Factors associated with shared decision-making as an innovation   
Lack of triability/Triability 2 [29, 49] 1 [29]
Lack of compatibility/Compatibility: 2 [29, 33] 2 [29, 33]
Complexity/Ease of use 3 [21, 29, 45] 2 [29, 56]
Lack of observability/Observable 1 [29] 1 [29]
Not communicable/Communicable 3 [29, 38, 49] 0
Increase uncertainty/Decrease or manage one's own uncertainty 1 [45] 1 [37]
Not modifiable/Modifiable 1 [37] 1 [29]
   • Factors associated with environmental factors   
Time pressure/Save time 18 [29, 34-39, 41-43, 47, 48, 50, 51, 53-57, 60] 3 [29, 42, 54, 55]
Lack of resources/Resources 4 [35, 47, 50, 53] 1 [50]
Organizational constraints/Organizational support 0 0
Lack of access to services/Access to services 2 [41, 60] 0
Lack of reimbursement/Reimbursement 0 0
Perceived increase in malpractice liability/Perceived decrease in malpractice liability 2 [47, 48] 0
Sharing responsibility with Patient Not applicable 3 [37, 42, 51]