Table 3 Perceived barriers and facilitators to implementation of shared decision-making in clinical practice
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 | ||
â—‹ Characteristics of the patient | 12 [21, 29, 34, 37, 41, 43, 47-49, 53-55, 59] | 4 [29, 35, 51, 54, 55] |
â—‹ 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 | ||
â—‹ 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 | ||
â—‹ Lack of triability/Triability | 2 [29, 49] | 1 [29] |
â—‹ Lack of compatibility/Compatibility: | 2 [29, 33] | 2 [29, 33] |
â—‹ Complexity/Ease of use | 3 [21, 29, 45] | 2 [29, 56] |
â—‹ Lack of observability/Observable | 1 [29] | 1 [29] |
â—‹ Not communicable/Communicable | 3 [29, 38, 49] | 0 |
â—‹ Increase uncertainty/Decrease or manage one's own uncertainty | 1 [45] | 1 [37] |
â—‹ Not modifiable/Modifiable | 1 [37] | 1 [29] |
   • Factors associated with environmental factors | ||
â—‹ Time pressure/Save time | 18 [29, 34-39, 41-43, 47, 48, 50, 51, 53-57, 60] | 3 [29, 42, 54, 55] |
â—‹ Lack of resources/Resources | 4 [35, 47, 50, 53] | 1 [50] |
â—‹ Organizational constraints/Organizational support | 0 | 0 |
â—‹ Lack of access to services/Access to services | 2 [41, 60] | 0 |
â—‹ Lack of reimbursement/Reimbursement | 0 | 0 |
â—‹ Perceived increase in malpractice liability/Perceived decrease in malpractice liability | 2 [47, 48] | 0 |
â—‹ Sharing responsibility with Patient | Not applicable | 3 [37, 42, 51] |