Barriers and facilitators to implementing shared decision-making in clinical practice: update of a systematic review of health professionals' perceptions.
OBJECTIVE
To update a systematic review on the barriers and facilitators to implementing shared decision-making in clinical practice as perceived by health professionals.


METHODS
From March to December 2006, PubMed, Embase, CINHAL, PsycINFO, and Dissertation Abstracts were searched. Studies were included if they reported on health professionals' perceived barriers and facilitators to implementing shared decision-making in practice. Quality of the included studies was assessed. Content analysis was performed with a pre-established taxonomy.


RESULTS
Out of 1130 titles, 10 new eligible studies were identified for a total of 38 included studies compared to 28 in the previous version. The vast majority of participants (n=3231) were physicians (89%). The three most often reported barriers were: time constraints (22/38) and lack of applicability due to patient characteristics (18/38) and the clinical situation (16/38). The three most often reported facilitators were: provider motivation (23/38) and positive impact on the clinical process (16/38) and patient outcomes (16/38).


CONCLUSIONS
This systematic review update confirms the results of the original review.


CONCLUSIONS
Interventions to foster implementation of shared decision-making in clinical practice will need to address a range of factors.
Légaré
France
F
Research Centre of the Centre Hospitalier Universitaire de Québec, Quebec, Canada. france.legare@mfa.ulaval.ca
Ratté
Stéphane
S
Gravel
Karine
K
Graham
Ian D
ID