title: Interventions for improving the adoption of shared decision making by healthcare professionals.
abstract: BACKGROUND
  Shared decision making (SDM) can reduce overuse of options not associated with benefits for all and respects patient rights, but has not yet been widely adopted in practice.
  
  
  OBJECTIVE
  To determine the effectiveness of interventions to improve healthcare professionals' adoption of SDM.
  
  
  METHODS
  For this update we searched for primary studies in The Cochrane Library, MEDLINE, EMBASE, CINAHL, the Cochrane Effective Practice and Organisation of Care (EPOC) Specialsied Register and PsycINFO for the period March 2009 to August 2012. We searched the Clinical Trials.gov registry and the proceedings of the International Shared Decision Making Conference. We scanned the bibliographies of relevant papers and studies. We contacted experts in the field to identify papers published after August 2012.
  
  
  METHODS
  Randomised and non-randomised controlled trials, controlled before-and-after studies and interrupted time series studies evaluating interventions to improve healthcare professionals' adoption of SDM where the primary outcomes were evaluated using observer-based outcome measures (OBOM) or patient-reported outcome measures (PROM).
  
  
  METHODS
  The three overall categories of intervention were: interventions targeting patients, interventions targeting healthcare professionals, and interventions targeting both. Studies in each category were compared to studies in the same category, to studies in the other two categories, and to usual care, resulting in nine comparison groups. Statistical analysis considered categorical and continuous primary outcomes separately. We calculated the median of the standardized mean difference (SMD), or risk difference, and range of effect across studies and categories of intervention. We assessed risk of bias.
  
  
  RESULTS
  Thirty-nine studies were included, 38 randomised and one non-randomised controlled trial. Categorical measures did not show any effect for any of the interventions. In OBOM studies, interventions targeting both patients and healthcare professionals had a positive effect compared to usual care (SMD of 2.83) and compared to interventions targeting patients alone (SMD of 1.42). Studies comparing interventions targeting patients with other interventions targeting patients had a positive effect, as did studies comparing interventions targeting healthcare professionals with usual care (SDM of 1.13 and 1.08 respectively). In PROM studies, only three comparisons showed any effect, patient compared to usual care (SMD of 0.21), patient compared to another patient (SDM of 0.29) and healthcare professional compared to another healthcare professional (SDM of 0.20). For all comparisons, interpretation of the results needs to consider the small number of studies, the heterogeneity, and some methodological issues. Overall quality of the evidence for the outcomes, assessed with the GRADE tool, ranged from low to very low.
  
  
  CONCLUSIONS
  It is uncertain whether interventions to improve adoption of SDM are effective given the low quality of the evidence. However, any intervention that actively targets patients, healthcare professionals, or both, is better than none. Also, interventions targeting patients and healthcare professionals together show more promise than those targeting only one or the other.
authors.affiliation: Population Health and Optimal Health Practices Research Axis, CHU de Québec Research Center, Université Laval, 10 Rue de l'Espinay, D6-727, Québec City, Québec, Canada, G1L 3L5.
authors.forename: France
authors.initials: F
authors.lastname: Légaré
authors.forename: Dawn
authors.initials: D
authors.lastname: Stacey
authors.forename: Stéphane
authors.initials: S
authors.lastname: Turcotte
authors.forename: Marie-Joëlle
authors.initials: MJ
authors.lastname: Cossi
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kryworuchko
authors.forename: Ian D
authors.initials: ID
authors.lastname: Graham
authors.forename: Anne
authors.initials: A
authors.lastname: Lyddiatt
authors.forename: Mary C
authors.initials: MC
authors.lastname: Politi
authors.forename: Richard
authors.initials: R
authors.lastname: Thomson
authors.forename: Glyn
authors.initials: G
authors.lastname: Elwyn
authors.forename: Norbert
authors.initials: N
authors.lastname: Donner-Banzhoff
mesh_terms: D003657:Decision Making; D003661:Decision Support Techniques; D006282:Health Personnel / Q000193:education*; D006801:Humans; D010353:Patient Education as Topic / Q000379:methods; D010358:Patient Participation; D016032:Randomized Controlled Trials as Topic