Patient-reported involvement in shared decision-making during medical consultations: a systematic literature review

Shared decision-making (SDM) involves patients and physicians working together to make healthcare decisions, thus providing patient-centered care. This study evaluates patients' reported participation in decision-making during medical consultations.

We searched the PubMed and Scopus electronic databases for studies on patient involvement, which were evaluated using the SDM-Q-9, OPTION (observing patient involvement), and CollaboRATE scales. We only included studies published from 2012–2022 that reported patient outcomes of involvement. Our team screened the titles and abstracts of each study for eligibility, collected general information, and evaluated methodological quality using the Joanna Briggs Institute (JBI) checklist.

The European Social Research Council guidance on the conduct of narrative synthesis in systematic reviews was utilized to thoroughly examine the level of patient participation in decision-making. After reviewing 8456 studies, we included 15 studies with a total of 23,697 participants in our final analysis. Of these, four studies were on psychiatry, cancer, and diabetes, with most studies conducted in the USA and UK, and one each in Malaysia, Saudi Arabia, and Uganda. Participants were predominantly female, most aged over 50 years. The studies involved patients with mixed levels of education. Studies on psychiatric patients reported positive involvement, with younger patients more involved in decision-making. Among cancer patients, educated people with a history of cancer were more involved, while participants from the Asian region demonstrated lower odds on univariate analysis. Among diabetic patients, good involvement in decision-making was observed. Only one study reported patient involvement from a lower-middle-income country (Uganda), and reported that 84% of the study population agreed that the doctor gave them enough time to discuss all their symptoms.

Our review thoroughly assesses the degree of patient involvement in healthcare decision-making. The studies we analyzed were conducted primarily in the USA and UK, and the findings indicate that younger and educated patients tend to be more actively engaged in the decision-making process. It is imperative that healthcare providers take action to ensure that patients are fully aware of the significance of their role in making informed healthcare decisions.