Table 2 Endogenous factors that promote or inhibit the implementation of DSTs

Interactional Workability

▪ Enrolling patients in shared decision-making

▪ Concept of shared decision-making

▪ Ensuring efficient and safe interactions.

▪ Making DST available

▪ New role as participant

▪ Integrating DST in the consultation

▪ Cognitive engagement with DST

▪ Managing time to process patients

▪ Understanding and assessing outcomes

▪ Managing patients who do not enter into shared decision-making

▪ Decisional responsibility

Relational Integration

▪ Linking DST to evidence base

▪ Making sense of clinical knowledge

▪ Assessing the value of evidence

▪ Confidence in applicability to individual patients.

▪ Agenda setting over treatment outcomes

▪ Understanding professional engagement

▪ Matching clinical evidence with patient knowledge

▪ Defining and evaluating 'best practice'

▪ Deciding on patients' accountability for engaging with DSTs

▪ Dealing with safety and liability.