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 = 323 1) 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 (16138). Conclusion: This systematic review update confirms the results of the original review. Practice implications: Interventions to foster implementation of shared decision-making in clinical practice will need to address a range of factors. (C) 2008 Elsevier Ireland Ltd. All rights reserved.