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Table 4 Taxonomy and frequency counts of pediatric SDM barriers and facilitators from multiple perspectives

From: Barriers and facilitators of pediatric shared decision-making: a systematic review

Influencing factor (# unique studies) Citations Barrier (B) and facilitator (F) (frequency counts)
HCP Parent Children Observer Total
Decision level (19) B F B F B F B F B F
 Option features (11) [67, 70, 84, 99, 109, 116, 117, 119, 120, 124, 125] 4   7   3 2   1 14 3
 High versus low stake decisions (9) [43, 46, 49, 50, 52, 84, 87, 99, 101] 2 3 1 2 1 4    4 9
 Availability of medical and research information (8) [67, 70, 84, 99, 107, 117, 119, 120, 124, 125]    4   1 2    5 2
 Atypical decision or uncomfortable topics (2) [64, 119] 1 1     1    1 1
 Totals 7 3 12 2 5 9   1 24 15
Innovation level (i.e., SDM) (34) B F B F B F B F B F
 Level of quality/tailored information that is given to the family (30) [54, 59, 60, 64, 68,69,70, 72, 73, 75, 80, 82,83,84, 91, 92, 96, 97, 102, 104, 106, 108, 109, 111, 112, 115, 116, 121, 124, 125]   8 4 11 8 9 1 1 13 31
 Impact of SDM on time (7) [50, 56, 64, 65, 104, 105, 116] 5 2     1    5 3
 Totals 5 10 4 11 8 10 1 1 18 34
Adopter level (i.e., HCP, parent, and child) (70) B F B F B F B F B F
 Attitudes (43)
  Agree with/desire for SDM/DM involvement (31) [58, 60, 64, 67,68,69,70, 72,73,74,75, 80, 81, 83, 85,86,87,88, 94, 102, 106, 109, 112, 113, 116, 119, 121, 124, 125, 127] 1 5 2 15 7 11    10 31
  Beliefs about consequences (7) [29, 30, 32, 50, 85, 99, 93, 95, 104]   4   3 1 3    1 10
  Parents/children cannot understand information (6) [56, 64, 70, 91, 105, 115] 5   1       6  
  Beliefs about capabilities (6) [59, 61, 64, 81, 103, 113, 124] 3 2 2 1 1     6 4
  Motivation (5) [50, 51, 56, 105, 125] 3 2 1 1 1     5 3
  Knowledge of SDM, policy (4) [29, 58, 105, 118] 4   2   1     7  
  Satisfied with current DM approach (3) [105, 107, 124] 1   1   2     4  
 Characteristics of the adopters (59)
  Child/parent health status (17) [38, 43, 44, 46, 48, 50, 51, 54, 5659, 64, 65, 69, 70, 75, 87, 90, 99, 101] 3 3 5 3 3 3   1 11 10
  Parent/child’s emotional state (16) [29, 34, 38, 41, 46, 55, 64, 66, 67, 77, 84, 87, 93, 95, 96, 99] 5 5 5 1 3   1   14 6
  Child’s age and competence (15) [29, 37, 38, 4244, 48, 5254, 70, 86, 87, 96, 99] 4 6   1 4 2    8 9
  HCP’s SDM skills (14) [29, 64, 66, 68, 69, 75, 95, 97, 99,100,101, 108, 116, 124] 3 3   1 2 1 5   10 5
  Parent/child race, ethnicity, culture, and language (7) [58, 67, 89, 93, 95, 103, 125] 3 2 2     1 1 6 2
  Parent socioeconomic status (7) [88,89,90, 93, 95, 104, 118]   2 1 3     1 1 6
  HCP age/seniority/specialty (6) [57, 58, 61, 73, 90, 123] 1 3    1   1   3 3
  Child’s behavior/maturity (6) [58, 67, 68, 79, 107, 119]   3 2 1 1     3 4
  Parent’s health insurance (5) [54, 59, 89, 93, 95, 109] 1 1 2     1   4 1
  HCPs role as advocate (6) [60, 73, 91, 111, 113, 115] 1 3   2   1    1 6
  Child experience with condition (4) [67, 69, 72, 104]   2     2     4
  HCP assuming parent/child preference for involvement (3) [61, 85, 112] 1   1   1     3  
  Parental absence during SDM discussion (2) [73, 110]       2     2
  Parent health literacy (2) [94, 125] 1   2       3  
  Parent’s sex or gender (2) [108, 123]     1     1   2
  Totals 39 44 29 33 28 25 9 4 111 108
Relational level (i.e., social influences) (49) B F B F B F B F B F
 Trust and respect in relationship (29) [30, 34, 41, 46, 49, 50, 52, 55, 61, 6368, 71, 72, 75, 80, 82, 84, 8789, 92, 96, 99, 104, 105] 2 7 2 13 1 7   1 5 28
 Extent adopters invite/support parent/child participation in DM (23) [29, 60, 66, 69,70,71, 75, 83, 92, 94, 96, 98, 102, 107,108,109, 111, 112, 115,116,117, 123, 124] 1 4 3 8 1 4 2 1 7 17
 Power relations (17) [66, 68,69,70, 73, 81, 87, 96, 106, 107, 110, 111, 114, 116, 119, 121] 3   3 1 9 1 1   16 2
 Biasing other adopters (12) [58, 59, 64, 74, 97, 99, 104, 109, 119, 120] 5   1   2   3   11  
 Recognition of HCP/parent expertise (6) [72, 81, 86, 87, 112, 124]   1 1 4 1     2 5
 Conflict (3) [64, 116, 119] 1   2   1     4  
Totals 12 12 12 26 15 12 6 2 45 52
Environmental level (37) B F B F B F B F B F
 Time (11) [29, 62,63,64, 69, 105, 107, 109, 119, 124, 125] 8 1 2   2     12 1
 Access to tools/resources/training to promote SDM (10) [52, 53, 55, 56, 65, 67, 82, 103, 104, 122, 125] 4 6   2   1    4 10
 Workflow and continuity of care (10) [63, 69, 84, 104, 105, 109, 115,116,117, 125] 8 2 2   1     11 2
 Norms (e.g., organizational policy consistent with SDM, expectations that HCP make the decision) (11) [29, 64, 68, 74, 94, 104, 105, 107, 113, 126] 5 2 3 1 4 1    12 4
 Clinical setting (e.g., emergency room) or situation (e.g., urgency) (8) [29, 58, 87, 104, 105, 107, 114, 127] 4 2 3 1 1     8 3
 Physical arrangement (e.g., seating) (3) [96, 104, 124] 1     1    1 2 1
 Stability of home environment (2) [59, 119] 1   1    1    2 1
 Totals 31 13 11 4 9 3   1 50 22
  1. *Qual qualitative, Quant quantitative, MM mixed methods, B barrier, F facilitator, HCP healthcare provider, SDM shared decision-making