Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium; Belgian Centre for Evidence-Based Medicine, Leuven, Belgium; JBI Belgium: A JBI Affiliated Group, Leuven, Belgium.
Patient Educ Couns. 2025 Jan;130:108475. doi: 10.1016/j.pec.2024.108475. Epub 2024 Oct 24.
We aim to provide an updated literature overview on patient-reported barriers and facilitators to participation in SDM across different patient groups and healthcare settings to uncover the 'common ground' and to reach for a more generalizable, uniform and inclusive insight in patients' perspective on participation in SDM.
We conducted a qualitative meta-summary, using five databases. Search terms were based on the concepts: 'decision-making', 'patient participation', 'patient perceptions' and 'study design' (of patient reporting).
We found 9265 unique references, selected 209 studies for further sampling and finally withheld 90 studies for further analysis in this review. In total, we identified 34 different barriers and facilitators. Based on most frequently reported barriers and facilitators, we defined four broad analytical themes corresponding to patients' shared expectations concerning doctors', patients' and others' facilitative roles in SDM: (1) 'Doctors explaining well', (2) 'Doctors listening well, and fostering a trusting relationship', (3) 'Patients being assertive, (4) 'Patients being socially supported'.
The majority of barriers and facilitators we found transcended differences in patient characteristics or healthcare setting, suggesting that patients are, overall, facing shared challenges and opportunities in SDM, that are mostly generalizable and irrespective of variabilities in decisional setting or patient group. We uncovered new trends such as patients' growing openness to assertiveness and the involvement of significant others, and highlighted some culture-based nuances, compared to earlier literature.
These new insights need to be integrated in SDM strategies so that they may serve the ethical imperative of a greater equality and inclusion of diverse patient groups in different SDM settings.
我们旨在提供一份关于不同患者群体和医疗环境中参与 SDM 的患者报告障碍和促进因素的最新文献综述，以揭示“共同点”，并对患者参与 SDM 的观点得出更具普遍性、一致性和包容性的认识。
我们使用五个数据库进行了定性元分析。检索词基于以下概念：“决策”、“患者参与”、“患者感知”和“研究设计”（患者报告）。
我们发现了 9265 个独特的参考文献，选择了 209 项研究进行进一步抽样，最终在本综述中保留了 90 项研究进行进一步分析。总共确定了 34 个不同的障碍和促进因素。基于报告最多的障碍和促进因素，我们定义了四个对应于患者对医生、患者和其他人在 SDM 中促进作用的共同期望的分析主题：（1）“医生解释得好”，（2）“医生倾听得好，并建立信任关系”，（3）“患者自信”，（4）“患者得到社会支持”。
我们发现的大多数障碍和促进因素超越了患者特征或医疗环境的差异，表明患者在 SDM 中总体上面临着共同的挑战和机遇，这些机遇在很大程度上是普遍存在的，与决策环境或患者群体的差异无关。与早期文献相比，我们发现了一些新趋势，例如患者越来越愿意表现出自信以及重要他人的参与，并强调了一些基于文化的细微差别。
这些新的见解需要纳入 SDM 策略中，以便在不同的 SDM 环境中为更大的平等和包容不同患者群体的伦理要求提供服务。
