Barriers and facilitators to shared decision-making in oncology: a systematic review of the literature
Shared decision-making (SDM) is a strategy to facilitate patient-centered care and is increasingly important in oncology, where patients are faced with complicated treatment decisions that require them to weigh efficacy and safety, quality of life, and cost. Understanding the contributors to the use of SDM may provide insight to its further implementation. Therefore, the objective of the study was to examine the patient-related barriers/facilitators to SDM in oncology care.
A systematic literature review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was executed. A search strategy composed of cancer, decision-making, and patient-centered terms was conducted utilizing PubMed, EBSCO MEDLINE, Scopus, CINAHL, and the Cochrane Library databases between January 2007 and November 2017. Full-text, US-based, English language articles describing the patient perspective of SDM in oncology care were included. Relevant data from articles were reviewed in a qualitative synthesis.
From 3435 potential citations, a total of 35 articles were included. The most common cancers studied were breast (n = 22; 62.9%) and prostate (n = 9; 25.7%). The identified themes for barriers to SDM were uncertainty in the treatment decision, concern regarding adverse effects, and poor physician communication. Themes for facilitators for SDM included physician consideration of patient preferences, positive physician actions and behaviors, and use or encouragement of support systems.
As SDM gains use within oncology practice, understanding key influences will allow for more effective implementation of strategies to increase patient engagement and improve care and value in the treatment process.
KeywordsNeoplasms Patient-centered care Patient participation Communication barriers
The authors thank David Nolfi, MLS, for his assistance in creating the search strategy for this review. The authors also thank Margaret English, Benjamin Lackner, Jonathan Kloss, Valerie Magda, and Cecelia Trybus for their assistance in executing this project.
Statement of funding source and role of sponsor
This study was funded by the Novartis Pharmaceuticals Corporation, who provided the concept, general oversight, and research collaboration on the project.
Compliance with ethical standards
Conflict of interest
Covvey and Kamal have received research funding from Novartis Pharmaceuticals Corporation and the College of Psychiatric and Neurologic Pharmacists. Rao has received funding from the College of Psychiatric and Neurologic Pharmacists for an unrelated project. Zacker is employed by Novartis Pharmaceuticals Corporation. Gorse was employed by AbbVie through an internship at the time of writing.
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