title: What are the external influences on information exchange and shared decision-making in healthcare consultations: a meta-synthesis of the literature.
abstract: OBJECTIVE
  To review the literature to identify external influences on information exchange and shared decision-making in healthcare consultations and conceptualise how information is used both outside and within a consultation.
  
  
  METHODS
  A 'meta-study' approach (meta-data-analysis, meta-theory, meta-method, and meta-synthesis) was used to locate, review, synthesise and summarise the findings, methodology, theoretical orientation and interpretation of qualitative research papers.
  
  
  RESULTS
  In a model of external influences on information exchange within healthcare consultations, practitioner influences were: receptiveness to informed patients and patient choice, lack of knowledge of cultural difference, patient centredness vs. stereotyping. Patient influences were: motivation to seek and engage with information; the appraisal of information before a consultation, expression of cultural identity, and ways of managing the risk of poor information. Shared influences were: differing illness notions, role expectations and language. Empowerment, disempowerment and non-empowerment were outcomes of information exchange and health literacy was a mediator of external influences and empowerment.
  
  
  CONCLUSIONS
  This meta-study provides a conceptualisation of external influences on information exchange in shared decision-making where health literacy mediates patient related influences and is also an influence on empowerment.
  
  
  CONCLUSIONS
  Our model can inform the development of interventions aimed at improving information exchange and shared decision-making, potentially contributing to more equitable healthcare encounters.
authors.affiliation: Department of Primary Care and Public Health, School of Medicine, Cardiff University, UK. Edwardsm6@cardiff.ac.uk
authors.forename: Michelle
authors.initials: M
authors.lastname: Edwards
authors.forename: Myfanwy
authors.initials: M
authors.lastname: Davies
authors.forename: Adrian
authors.initials: A
authors.lastname: Edwards
mesh_terms: D000328:Adult; D000368:Aged; D000884:Anthropology, Cultural; D003144:Communication Barriers; D018864:Cultural Diversity; D003657:Decision Making; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D011209:Power, Psychological; D011369:Professional-Patient Relations; D036301:Qualitative Research