Article type
Year
Abstract
Background: Shared decision making (SDM) has not yet been widely adopted in clinical practice. Effective interventions for improving the adoption of SDM by healthcare professionals need to be identified.
Methods: An update of the 2010 Cochrane systematic review was performed by searching Cochrane Library, Medline, Embase, Cinahl, Epoc, PsycInfo, clinicaltrials.gov registry, and relevant conference proceedings up to March 31, 2012. Authors of relevant studies were also contacted. We included randomized controlled trials or well-designed quasi-experimental studies, eligible if the outcome was evaluated with an observer-based outcome measure (OBOM) or if the occurrence of SDM was a patient-reported outcome measure (PROM). Two authors independently screened titles and abstracts, assessed studies for eligibility, assessed risk of bias and extracted data. Statistical analysis considered categorical and continuous data for primary outcomes and we computed the standard effect size for each outcome separately with a 95% confidence interval. We also evaluated global effects by calculating mean effect size and the range of effect sizes across studies.
Results: Combining this update with the last review, 39 studies were included: 9 OBOMs, 27 PROMs and 3 studies using both. Most did not have significant results. Seven OBOMs and 7 PROMs had significant effect size, indicating occurrence of SDM. Interventions evaluated were diverse. A significant effect was found in 0.14% of studies targeting the patient, 0.27% of studies targeting the healthcare professional and 0.41% of studies targeting both (p < 0.11). Educational meetings, use of patient decision aids and distribution of educational materials were elements most used to enhance adoption of SDM in all included studies.
Conclusions: Robust conclusions could not be drawn by this review due to the variability in interventions. The conclusions of this update concur with the earlier review. More studies are needed to identify interventions that improve adoption of SDM by healthcare professionals.
Methods: An update of the 2010 Cochrane systematic review was performed by searching Cochrane Library, Medline, Embase, Cinahl, Epoc, PsycInfo, clinicaltrials.gov registry, and relevant conference proceedings up to March 31, 2012. Authors of relevant studies were also contacted. We included randomized controlled trials or well-designed quasi-experimental studies, eligible if the outcome was evaluated with an observer-based outcome measure (OBOM) or if the occurrence of SDM was a patient-reported outcome measure (PROM). Two authors independently screened titles and abstracts, assessed studies for eligibility, assessed risk of bias and extracted data. Statistical analysis considered categorical and continuous data for primary outcomes and we computed the standard effect size for each outcome separately with a 95% confidence interval. We also evaluated global effects by calculating mean effect size and the range of effect sizes across studies.
Results: Combining this update with the last review, 39 studies were included: 9 OBOMs, 27 PROMs and 3 studies using both. Most did not have significant results. Seven OBOMs and 7 PROMs had significant effect size, indicating occurrence of SDM. Interventions evaluated were diverse. A significant effect was found in 0.14% of studies targeting the patient, 0.27% of studies targeting the healthcare professional and 0.41% of studies targeting both (p < 0.11). Educational meetings, use of patient decision aids and distribution of educational materials were elements most used to enhance adoption of SDM in all included studies.
Conclusions: Robust conclusions could not be drawn by this review due to the variability in interventions. The conclusions of this update concur with the earlier review. More studies are needed to identify interventions that improve adoption of SDM by healthcare professionals.