Patient Education and Counseling 129 (2024) 108408

Contents lists available at ScienceDirect

Patient Education and Counseling

journal homepage: [Link]/patient-education-and-counseling

The effects of shared decision making on health outcomes, health care

quality, cost, and consultation time: An umbrella review
Joseph Dov Bruch a, Maram Khazen b, Mersiha Mahmic-Kaknjo c,d, France Légaré e,f,
Moriah E. Ellen g,h,*
a
Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
b
The Max Stern Yezreel Valley College, Emek Jezreel, Israel
c
Department of Clinical Pharmacology, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina
d
Faculty of Medicine, University of Zenica, Zenica, Bosnia and Herzegovina
e
VITAM – Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec City, QC, Canada
f
Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada
g
Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the
Negev, Beer-Sheva, Israel
h
Institute of Health Policy Management and Evaluation, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada

A R T I C L E I N F O A B S T R A C T

Keywords: Objective: To review the effects of shared decision making (SDM) on health outcomes, health care quality, cost,
Shared decision making and consultation time
Umbrella review Methods: We conducted an umbrella review and searched systematic reviews on SDM from PubMed, CINHAL,
Knowledge translation
and Web of Science. We included reviews on SDM interventions used in a health care setting with patients. We
Knowledge mobilization
Patient engagement
assessed the eligibility of retrieved articles and evaluated whether the review addressed Consolidated Framework
for Implementation Research (CFIR) characteristics.
Results: Out of 3678 records, 48 reviews were included. Half of the reviews focused exclusively on RCT studies (n
= 21). A little less than half were focused specifically on decision aids (n = 23). Thirty-two reviews discussed
CFIR characteristics explicitly or implicitly; the majority of which were specific to intervention characteristics.
Reviews tended to cluster around patient populations and tended to be low or critically low to moderate in their
quality. Reviews of SDM on health outcomes, health care quality, cost, and consultation time were highly un-
certain but often ranged from neutral to positive.
Conclusions: We observed that SDM implementation did not typically increase costs or increase consultation time
while having some neutral to positive benefits on outcomes and quality for certain populations. Gaps in
knowledge remain including better research on the climate where SDM is most effective.

1. Introduction systematic reviews found that evidence of SDM reducing costs or

improving health care quality was inconsistent.[5,9].
Shared decision-making (SDM) is a process where clinicians, pa- SDM research has accelerated across health services and health
tients, and caregivers work in tandem to make informed decisions about policy literatures, with thousands of research studies focused on its use
a patient’s health.[1–3] Patients who participate in SDM feel more and effectiveness. Because of its popularity, several reviews on SDM
informed about their care,[4] and may report having greater knowledge synthesize the literature, often within a specific dimension, such as a
about their medical state and the risks of certain treatments.[5] medical condition, medical setting, intervention type, or population
Increasingly, policymakers and national health organizations across the type.
globe have called for greater SDM in health care settings.[6–8] Despite An umbrella review, or a review of systematic reviews, can be an
numerous studies on SDM across a range of health care settings, the important method of organizing diverse scholarship that varies across a
effects of implementing SDM in clinical practices remain unclear. Earlier range of medical dimensions.[10] Umbrella reviews can reveal gaps in

* Correspondence to: Ben-Gurion University of the Negev, POB 653, Beer-Sheva, Israel.
E-mail address: ellenmo@[Link] (M.E. Ellen).

[Link]
Received 7 January 2024; Received in revised form 18 August 2024; Accepted 19 August 2024
Available online 24 August 2024
0738-3991/© 2024 Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
J.D. Bruch et al. Patient Education and Counseling 129 (2024) 108408

the literature and areas where the quality of evidence is limited. An outcomes: health outcomes, health care quality, cost, or consultation
umbrella review can be particularly relevant to policymakers, managers time. Health care quality outcomes included, but were not limited to,
of health care systems, and health professionals who are increasingly medication and treatment adherence, quality of care scores, and receipt
being asked to find meaningful ways to incorporate SDM into the health of guideline-concordant care. Articles that did not partially or fully focus
system. Umbrella reviews are also an effective method for informing on one or more of these outcomes were also excluded. The three re-
decision-making on issues that are of high priority to patients and the viewers then extracted data from their assigned articles using an Excel-
public where evidence appraisal and synthesis are necessary.[11,12]. based extraction tool. Data were extracted using PICO guidelines (par-
We pursued an umbrella review in order to identify 1) the health care ticipants, interventions, comparison, outcome measures). One author
dimensions where SDM interventions have been studied, such as by went through and validated the PICO data extracted. The reviewers also
condition, setting, intervention type, or population type, 2) the out- recorded data on risk of bias using the AMSTAR-2 tool.[17] Reviews
comes that have been studied within each of these dimensions, 3) the were classified into three categories. Reviews that met all AMSTAR-2
effects of these SDM interventions on these outcomes within these di- requirements were classified as "high." Reviews that had more than
mensions, 4) the quality of the reviews, and 5) the implementation one non-critical weakness were classified as "moderate." Reviews that
science factors that have been studied or included in the literature. had one critical flaw or more were classified as "low or critically low".
The three reviewers then evaluated whether the systematic review
2. Methods addressed any of the 2009 CFIR (Consolidated Framework for Imple-
mentation Research) characteristics.[18] CFIR is a conceptual frame-
2.1. Study design work used to evaluate the implementability of an intervention within a
complex setting. CFIR is broken down into 5 domains which can be used
We conducted an umbrella review whose purpose was to synthesize to evaluate potential barriers and facilitators to successful imple-
the findings of available reviews. We adopted the Joanna Briggs Institute mentation. These domains include the intervention characteristics (the
(JBI) methodology for umbrella reviews [13] and the Preferred features and quality of the intervention), the outer setting (the social and
Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) political environment outside the organization where the intervention is
2020 guidelines to structure this review.[14] The study protocol was delivered), the inner setting (the social and political environment of the
registered with the International Prospective Register of Systematic organization itself where the intervention is delivered), the individuals
Reviews (PROSPERO 2022, CRD42022343135) on July 10, 2022. domain (the behaviors of the individuals in the organization where the
intervention is being delivered), and the implementation process
2.2. Information sources domain (the strategies used to implement the intervention). Using CFIR
allows researchers to identify when there is insufficient evidence within
Using a search methodology similar to a previous study,[15] we a domain and propose future research directions.[19] Employing the
targeted research reviews on SDM from PubMed, CINHAL, and Web of CFIR framework, reviewers identified whether the review explicitly or
Science. General terms included: “shared decision,” “decision aid,” implicitly employed one or multiple domains. For example, if a review
“decision making,” “shared decision making,” “decision support tech- described local policies or medical requirements that enhanced SDM
niques,” “decision-making process,” “patient participation,” and “pa- implementation, we indicated that the review engaged with the “outer
tient involvement.” We include some of the primary search strategies in setting” domain. If a review described policies or requirements at the
Appendix A. provider’s office that enhanced SDM implementation, we indicated that
the review engaged with the “inner setting” domain. If a review dis-
2.3. Eligibility criteria for screening cussed communication styles that best fostered SDM, we indicated that
the review engaged with the “implementation process” domain.
A review was eligible for inclusion in the umbrella review if it: 1)
explicitly described itself as a review, 2) focused on SDM in a health care 3. Results
setting with patients, and 3) was written in English. SDM interventions
included, but were not limited to, decision coaching, decision aids, and We found a total of 3678 citations from PubMed (n = 2081), CINHAL
question prompt lists. A review was eligible for inclusion even if the (n = 523), and Web of Science (n = 1074) (Fig. 1). We found 751 du-
review did not evaluate whether the SDM intervention successfully plicates, leaving 2927 unique reviews. We further removed 2680 re-
promoted SDM. We excluded reviews that exclusively focused on out- views after the abstract review and 200 reviews after the full-text
comes related to the patient’s psychological experience with the medical screening. Forty-eight reviews were included in this umbrella review,
decision (e.g., "levels of anxiety related to medical decisions" or "patient which were published between 2000 and 2021. We included one review
satisfaction"). However, we included reviews if the outcome measured that was not identified through our search strategy but met our inclusion
the patient’s mental health broadly, irrespective of the medical decision. criteria.[20] Half of the reviews focused exclusively on RCT studies (n =
21) (Table 1). While there was a variety of SDM interventions, most
2.4. Selection of sources of evidence and data extraction reviews were focused on decision aids (n = 23). Using the AMSTAR-2
tool, 37 reviews were judged low or critically low quality, 7 moderate
Upon compiling all articles produced from the search, two reviewers quality, and 4 high quality.
independently screened the titles and abstracts for the outlined inclusion
criteria. These two reviewers met after screening the first 200 articles 3.1. Health outcomes
and discussed any conflicts before pursuing additional screening. After
all articles were screened, the two reviewers met again and resolved any Thirty-seven reviews synthesized information on health outcomes.
additional conflicts in screenings. Covidence systematic review software Reviews focused on a range of health conditions. Reviews that focused
(Veritas Health Innovation, Melbourne, Australia) was used to conduct on patients with mental health disorders found little consistent effect of
these preliminary screenings.[16]. SDM on health outcomes, like depressive symptoms,[21] quality of life,
Three reviewers were assigned a third of the included articles to [22] or hospital readmission rates.[23] However, one review found that
individually conduct full text reviews. The reviewers verified again that a positive and collaborative therapeutic alliance, which may include
their assigned articles were systematic reviews and excluded those that SDM, was associated with reduced suicide risk for those with Bipolar
were not. The reviewers then identified whether each of their assigned disorder.[24] Among patients with mental health conditions
articles focused partially or fully on one or more of the following co-occurring with alcohol/other drug use (AOD), patients who were

2
J.D. Bruch et al. Patient Education and Counseling 129 (2024) 108408

3678 records identified from 3

751 duplicate records removed before

Identification
databases (PubMed, CINHAL, and
screening
Web of Science)

2927 Records screened 2680 records excluded

Screening

247 Reports sought for retrieval 0 Reports not retrieved

247 Reports assessed for eligibility

200 Reports excluded:
Not on outcomes (n =154)
Not English (n =1)
Not systematic review (n =45)

48 studies included in review

Included

(we included one review that was

not identified through our search
strategy but met our inclusion
criteria)

Fig. 1. Identification of studies.

randomized to receive motivational interviewing and SDM experienced There were several reviews focused on the use of SDM in a clinical
better improvements in terms of psychiatric severity compared to those population with a chronic disease. For example, a review described
who received usual care.[22]. lower hospitalization rates among HIV/AIDS patients using a computer-
Several reviews (n = 10) that looked at the effects of SDM on com- based decision aid with group discussion compared to patients who
posite quality of life scores also found no evidence or little evidence of an received usual care.[35] A review, which was focused on adults with
effect [21,22,25–32], except for one study focused on the use of decision hypertension who were given an SDM intervention, found no difference
aids for early-stage breast cancer patients which generally found in blood pressure between intervention and control groups in any study.
improved quality of life.[33] Authors in one review with the largest [39] Two reviews focused on patients with diabetes found little evidence
number of studies (n = 87), which focused on improving SDM among of an association between SDM interventions and glycemic control.[29,
healthcare professionals, concluded that it was uncertain whether in- 40].
terventions targeting patients improved physical or mental
health-related quality of life.[28] The authors of this review attributed
3.2. Health care quality
the uncertainty to the limited number of studies focused on SDM and
quality of life. This sentiment was shared in other reviews.[34,35].
There were 36 reviews that evaluated health care quality measures.
Reviews that considered SDM in the use of primary care clinics found
One review that was focused on people facing a decision about osteo-
little evidence of major health benefits;[36,37] although, one review did
porosis treatment or fracture prevention strategies in patients with
find that some health benefits were observed when patients increased
osteoporosis found no differences in adherence when using a decision
adherence to treatments following SDM.[38].
aid. Another review found that for people from culturally and

3
J.D. Bruch et al. Patient Education and Counseling 129 (2024) 108408

Table 1
Characteristics of Review Articles Included.
Outcomes Assessed in the Reviews
*

Title Study Population Intervention Comparison Study Type Quality Cost Health Time

Use of decision aids for Barnes 2016 Patients with venous Decision aids No comparison Cohort studies + + - -
shared decision thromboembolism
making in venous
thromboembolism: A
systematic review
[50]
Feasibility and efficacy Berlin 2019 Patients making a Decision aids Multiple Multiple - - - +
of decision aids to decision on breast comparisons Study Types
improve decision reconstruction
making for
postmastectomy
breast
reconstruction:
A systematic review
and meta-analysis
[54]
Patient decision aid in Bruel 2020 Those considering a All decision aids Multiple Multiple + - - -
vaccination: a vaccine that were vaccine- comparisons Study Types
systematic review of related
the literature[65]
Involving older people Butterworth Older people with All forms of SDM Multiple RCTs, cluster + + + -
with multimorbidity 2020 multimorbidity during comparisons RCTs, and
in decision-making primary care quasi RCTs
about their primary consultations
healthcare: a
Cochrane systematic
review of
interventions[37]
The impact of patient Clayman 2016 All patients Attempt to increase Usual care, Multiple + + + +
participation in patient attention control, or Study Types
health decisions participation in no choice
within medical decisions
encounters:
A systematic review
[66]
Shared decision- Coronado- All patients Shared decision- Standard practice RCTs and + - + +
support tools in Vazquez 2019 support tools controlled
hospital emergency clinical trials
departments: a
systematic review
[67]
Interventions to Coronado- Primary care setting All forms of SDM Multiple RCTs + - + -
facilitate shared Vá zquez 2020 comparisons
decision-making
using decision aids
with patients in
Primary Health Care:
A systematic review
[38]
Interventions to Coxeter 2015 Clinicians and patients All forms of SDM Usual care RCTs + - + -
facilitate shared
decision making to
address antibiotic use
for acute respiratory
infections in primary
care[44]
Impact of decision aids Dobler 2019 Clinicians Decision aids Multiple RCTs + - - +
used during clinical comparisons
encounters on
clinician outcomes
and consultation
length: a systematic
review[20]
Shared decision making Duncan 2010 Patients with mental All forms of SDM Multiple Multiple + - + +
interventions for health disorders comparisons Study Types
people with mental
health conditions
[23]
Interventions for Dwamena 2012 Clinicians Clinician Multiple RCTs + - + +
providers to promote interventions aimed comparisons
a patient-centered to promote patient-
centered care
(continued on next page)

4
J.D. Bruch et al. Patient Education and Counseling 129 (2024) 108408

Table 1 (continued )
Outcomes Assessed in the Reviews
*

Title Study Population Intervention Comparison Study Type Quality Cost Health Time

approach in clinical approaches in

consultations[30] clinical
consultations.
Communication and Fisher 2016 Cognitively competent Clinician-patient Multiple Cross- + - + +
decision-making in adult patients (>18 communication comparisons sectional
mental health: a yrs) with a diagnosis of and/or decision-
systematic review bipolar disorder (BP) making
focusing on bipolar receiving medical care
disorder[24]
Shared decision- Fisher 2021 Mental health All forms of SDM Multiple Multiple + - + +
making among (depression, post- comparisons Study Types
people with traumatic stress
problematic alcohol/ disorder,
other drug use and schizophrenia/
co-occurring mental schizoaffective
health conditions: a disorder, generalized
systematic review anxiety disorder, and
[22] bipolar disorder) co-
occurring with
alcohol/other drug use
(AOD)
Patient-mediated Gagliardi 2016 Arthritis or cancer Patient-mediated Multiple Multiple - - + +
knowledge patients in ambulatory knowledge comparisons Study Types
translation settings immediately translation
(PKT) interventions before, during, or upon (PKT) interventions
for clinical conclusion of clinical
encounters: a encounters
systematic review
[68]
Effects of shared Geerse 2018 Patients with lung The facilitation of Multiple Multiple + - + -
decision making on cancer SDM, either as part comparisons Study Types
distress and health of a supportive care
care utilization intervention or by
among patients with use of a decision aid
lung cancer: a
systematic review
[69]
Interventions to Harun 2013 Patients from Decision aid Multiple Multiple + - + -
improve patient culturally and comparisons Study Types
participation in the linguistically diverse
treatment process for (CALD) groups
culturally and
linguistically diverse
people with cancer: A
systematic review
[41]
Outcome-relevant Hauser 2015 All patients All forms of SDM Multiple RCTs + - + -
effects of shared comparisons
decision making[70]
Video decision aids to Jain 2015 Enrolled adult patients Advance care No ACP video RCTs + - - -
assist with advance (age 18 years or older) planning (ACP) decision aid
care planning: a in an inpatient or video decision aid component (e.g.,
systematic review outpatient setting sham video,
and meta-analysis traditional methods
[71] of decision support
such as verbal
description,
pamphlets, usual
care, or no
discussion)
What Is Lacking in Jimbo 2013 All patient populations Decision aids for the Multiple Multiple + + - -
Current Decision Aids who received one of screening of cancer comparisons Study Types
on Cancer Screening? the decision aids
[72] considered
Interventions to Johnson 2018 Adults with All forms of SDM Multiple Multiple + - + -
support shared hypertension comparisons Study Types
decision making for
hypertension: A
systematic review of
controlled studies
[39]
Systematic review of Joosten 2008 All patients All forms of SDM Multiple RCTs + - + -
the effects of shared comparisons
(continued on next page)

5
J.D. Bruch et al. Patient Education and Counseling 129 (2024) 108408

Table 1 (continued )
Outcomes Assessed in the Reviews
*

Title Study Population Intervention Comparison Study Type Quality Cost Health Time

decision-making on
patient satisfaction,
treatment adherence,
and health status[73]
Decision aids for people Karagiannis 2019 People with Type 2 Decision aid Multiple RCTs and + - + -
with Type 2 diabetes diabetes mellitus comparisons cluster RCTs
mellitus: an
effectiveness rapid
review and meta
analysis[40]
Shared decision- Kashaf 2017 Adults (18 years) with All forms of SDM Multiple Multiple + - + -
making and a clinical diagnosis of comparisons Study Types
outcomes in type 2 type 2 diabetes
diabetes: a systematic
review and meta-
analysis[29]
Decision aids for Knops 2013 Patients facing a A decision aid for Multiple Multiple - + + -
patients facing a surgical treatment patients facing a comparisons Study Types
surgical treatment decision choice between
decision: a systematic surgery and 1 or
review and meta- more alternative
analysis[31] management
options.
Interventions for shared Kryworuchko Adults (decisions about All forms of SDM Usual care RCTs - - + -
decision-making 2013 the use of life support
about life support in in the intensive care
the intensive care unit)
unit: a systematic
review[74]
Shared decision making Kuehne 2020 Adult patients (18 All forms of SDM Multiple RCTs and + - - -
enhances years and above) in comparisons cluster RCTs
pneumococcal outpatient care in high-
vaccination rates in income countries
adult patients in
outpatient care[75]
The promise of Kuo 2018 All patients EHR inter- ventions Multiple Multiple - - + -
electronic health that influenced the comparisons Study Types
records to promote SDM process
shared decision
making:
a narrative review
and a look ahead[76]
Effectiveness of Leatherman All patient populations Decision aids Multiple Multiple + + + +
decision aids: a 2008 comparisons Study Types
review of the
evidence[35]
Interventions for Legare 2018 Healthcare All forms of SDM Multiple Multiple + + + +
increasing the use of professionals and comparisons Study Types
shared decision patients
making by healthcare
professionals[28]
Interventions for Malone 2019 Person with cystic All forms of SDM No intervention RCTs + - + +
promoting fibrosis (4 − 18 years
participation in and older)
shared decision-
making for children
and adolescents with
cystic fibrosis[34]
The impact of shared Marshall 2021 Adults (aged 18–64 All forms of SDM Multiple Randomised + - + +
decision-making on years) with anxiety comparisons or non-
the treatment of and/or depressive randomised
anxiety and disorders prospective
depressive disorders: controlled
systematic review trials
[21]
Feasibility and effects Molenaar 2000 All patients Decision aids Multiple Multiple - - + -
of decision aids[77] comparisons Study Types
Decision aids for people O’Connor 2009 People who were Decision aids Multiple RCTs + + + +
facing health making decisions about comparisons
treatment or screening or treatment
screening decision options for themselves,
[53] for a child, or an
(continued on next page)

6
J.D. Bruch et al. Patient Education and Counseling 129 (2024) 108408

Table 1 (continued )
Outcomes Assessed in the Reviews
*

Title Study Population Intervention Comparison Study Type Quality Cost Health Time

incapacitated
significant other
Quality and Paskins 2020 People facing a Decision aids Multiple Multiple + - + -
effectiveness of decision about comparisons Study Types
osteoporosis osteoporosis treatment
treatment decision or fracture prevention
aids: a systematic strategies in patients
review and with osteoporosis.
environmental scan
[32]
Patient decision aids to Poprzeczny 2020 Obstetrics and Decision aids Multiple RCTs - + -
facilitate shared gynecology patients comparisons
decision making in
obstetrics and
gynecology: a
systematic review
and meta-analysis
[52]
Shared decision- Riddle 2021 Patients considering Proprietary Usual care or RCTs - - + +
making applied to knee arthroplasty (KA) decision aid another active
knee arthroplasty: a for the management of (Treatment Choices control
systematic review of any type of knee for Hip or Knee
randomized trials arthritis (including Osteoarthritis)
[26] osteoarthritis, developed by the
rheumatoid arthritis, Foundation for
or posttraumatic Informed Medical
arthritis) Decision-Making
Shared decision- Samalin 2018 Mood disorders: Decision aids and Care as usual RCTs + + + +
making: a systematic dysthymia, major collaborative care
review focusing on depressive disorder
mood disorders[27] MDD, or bipolar
disorder BD type I and
type II
Effects of improved Sanders 2013 All patients All patient-centered Multiple Cluster RCTs + + + -
patient participation interventions aimed comparisons
in primary care on at affecting
health-related patients’ ability to
outcomes: a influence treatment
systematic review decisions during
[36] primary care
encounters.
Assessing the impact of Sanftenberg Adult patients in All forms of SDM Multiple RCTs and + - - -
shared decision 2021 outpatient care comparisons cluster RCTs
making processes on
influenza vaccination
rates in adult patients
in outpatient care
[42]
The impact and utility Scalia 2019 All patients Decision aids Usual care without Multiple - + + +
of encounter patient an encounter PDA, Study Types
decision aids: the use of a pre-
Systematic review, encounter PDA for
meta-analysis and use
narrative synthesis independently by
[78] patients, and other
types of educational
content (pamphlets,
guidelines,
booklets) provided
to patients before,
during, or after
their visit, but not
defined as an
encounter PDA.
Where is the evidence? Shay 2015 Clinicians and patients All forms of SDM Multiple Multiple + - + -
A systematic review comparisons Study Types
of shared decision
making and patient
outcomes[79]
Decision aids on breast Si 2020 All patients for breast Decision aids that Multiple Multiple - - + -
conserving conserving surgery specifically targets comparisons Study Types
surgery for early breast conserving
stage breast cancer surgery
(continued on next page)

7
J.D. Bruch et al. Patient Education and Counseling 129 (2024) 108408

Table 1 (continued )
Outcomes Assessed in the Reviews
*

Title Study Population Intervention Comparison Study Type Quality Cost Health Time

patients: a systematic
review[33]
Decision coaching to Stacey 2012 Patients making Decision coaching Multiple RCTs + + + +
prepare patients for screening or treatment with patient comparisons
making health decisions decision aids
decisions: a
systematic review of
decision coaching in
trials of patient
decision aids[80]
Coaching and guidance Stacey 2013 All patient populations Coaching/guidance Multiple Multiple + + - -
with patient decision in the context of comparisons Study Types
aids: A review of decision aids (sub-analysis
theoretical and of randomized
empirical evidence controlled
[51] trials)
Decision aids for people Stacey 2017 All patient populations Decision aid Multiple RCTs + + + +
facing health comparisons
treatment or
screening decisions
[5]
Decision aids for Violette 2015 Patients with localized Decision aid Multiple RCTs - + + +
localized prostate prostate cancer intervention for comparisons
cancer treatment localized prostate
Choice: systematic cancer
review and meta-
analysis[25]
Can electronic Wickramasekera All patients Electronic clinical Multiple Multiple - - - +
assessment tools 2023 assessment tool/ comparisons Study Types
improve the process questionnaires
of shared decision-
making? A systematic
review[81]
Expanding the concept Zisman-Ilani Participants with a All forms of SDM Multiple Multiple + - + +
of shared decision 2017 mental illness facing a comparisons Study Types
making for mental mental health care
health: Systematic decision, their
search and scoping caregivers, and
review of providers
interventions[82]
*
+ denotes that the study included the dimension. - denotes that the study did not include the dimension

linguistically diverse backgrounds, decision aids increased patients’ included only RCTs. These seven reviews identified variability and gaps
perception of treatment adherence.[41] A review assessing the impact of in the types of settings and quality of care measures where SDM has been
SDM processes on influenza vaccination rates found increases in vacci- studied. For example, one review concluded that there were no studies
nation rates in adult patients in outpatient care.[42] A review on deci- focused on the use of video decision aids when integrated into clinical
sion aids for people with Type 2 diabetes mellitus found that decision care for advance care planning.[48] Another found that it was not
aids were no more effective in increasing adherence to medication up- possible to assess the effect of decision aids on adherence because of
take than usual care.[40] Similarly, an earlier review that examined variability in measurement strategies.[5] Finally, one review concluded
SDM found that there was no difference across multiple SDM in- that the varying definitions of SDM across studies made it challenging to
terventions on adherence to blood pressure medication in patients with conclude the effects of decision aids on medication adherence.[49].
hypertension.[43] The authors of two reviews noted that insufficient
data prevented them from drawing conclusions on the quality impacts of 3.3. Cost
SDM interventions.[23,44].
Four reviews included clinicians in their population of interest and Sixteen reviews included information on cost. One review identified
measured health care quality outcomes. In these studies, either the two studies where using a decision aid reduced the total costs of treating
outcome measures were clinician-reported or the SDM intervention menorrhagia compared to patients who did not receive the decision aid.
targeted clinicians. One review that was limited to RCTs (individual [31] One review, which focused on the use of decision aids in patients
level or cluster-randomised) found moderate quality evidence that SDM with venous thromboembolism, observed possible cost reductions for
interventions reduce antibiotic use for acute respiratory infections in patients who avoided testing after receiving a decision aid.[50] Another
primary care.[45] Another review found mixed results for treatment review that examined studies on all patient populations found evidence
adherence and related outcomes; results varied by whether outcomes that decision aids and decision coaching compared to usual care
were analyzed using dichotomous measures or continuous measures. decreased mean costs.[51] Decision aids were also found to be
[46] A third review included all SDM intervention types and found that cost-effective in a review of patient decision aids delivered in obstetrics
0% of SDM interventions were significantly and positively associated and gynecology settings.[52].
with patient outcomes, including quality of care outcomes.[47]. Several Cochrane reviews on SDM included cost as a primary or
Fifteen reviews were exclusively focused on the use of decision aids secondary outcome of interest. One of these reviews included all studies
and focused on quality of care outcomes. Of these 15 reviews, seven with decision aids and found inconclusive evidence on the effects of

8
J.D. Bruch et al. Patient Education and Counseling 129 (2024) 108408

decision aids.[5] Another review found no observed differences in findings are important as clinicians already report limited time to spend
health care resource use for those who were given a decision aid with patients and there is concern that efforts to introduce SDM may
compared to those who did not.[53] A third review determined there further constrain clinicians’ time.[57,58] A recent review and
was insufficient evidence to evaluate the costs associated with SDM meta-analysis published after our search also found that SDM-promoting
interventions that target health care professionals.[28]. interventions do not increase consultation time overall, except in pri-
mary care settings, group formats, settings where SDM only targeted
3.4. Time clinicians, or settings where the SDM intervention was not theory-based.
[59].
Twenty-two reviews evaluated the influence of SDM on consultation Reviews found that SDM generally either reduced costs or had little
time. One review described two earlier studies that both found no dif- effect on costs at all. This is important since researchers suggest that
ference in consultation time for patients who received a decision aid and financial interests were perceived as a barrier to implementing SDM.
those who did not.[35] A review examining the use of decision aids to [60] Even if the existing research does not show that SDM increases total
improve decision-making for postmastectomy breast reconstruction cost, clinicians may still see it as a barrier as it does require effort to
found one study where consultation time decreased.[54] In a review of maintain SDM in the clinical practice. Thus, greater attention towards
all SDM interventions for adults with anxiety and/or depressive disor- reimbursing clinicians for SDM is warranted. Finally, few of the reviews
ders, no differences in consultation time were found.[21] Similarly, a found evidence of changes in health care quality.
review focused on mood disorders found no difference in consultation The benefits of SDM ultimately are intrinsic to the goals of patient
time when patients received an SDM intervention,[27] neither did a centered care (PCC), or care that focuses on the wants, needs, and
review focused on patients with mental health conditions.[23] Addi- preferences of the patient.[1,61] Although there has been significant
tionally, one review that examined 10 studies where a decision aid was talk about the need to elevate PCC within health systems, it remains
administered found only two studies where longer encounter times were challenging to operationalize SDM.[1] While several of the reviews
reported for the treatment group.[5] One of the few reviews focused on incorporated the vision of PCC, few discussed the communication styles
patient-mediated knowledge translation (PKT) found no evidence that that help establish physician-patient partnerships. This is likely because
PKT increased consultation length.[55] Finally, a review on the use of existing studies tend to focus on the behaviors and techniques that help
decision aids for localized prostate cancer found no studies that exam- facilitate SDM over the communication styles that build
ined consultation time.[56]. physician-patient partnerships.[62,63] Future studies might focus on
There was only one review focused on decision aids that was limited how each implementation strategy can be tailored to address different
to RCT studies and that included a standard care control group. This barriers and facilitators of SDM uptake. While prominent attributes for
study focused on patients with mood disorders and found the use of the SDM implementation efforts include resource access and work structure,
decision aid did not change the duration of the visit.[49]. [64] structural (e.g., including policy) changes may most meaningfully
establish SDM in the clinical workflow. Ultimately, understanding
3.5. CFIR characteristics implementation is crucial because it provides context for the results and
helps in interpreting SDM outcomes more accurately. For example,
Thirty-two reviews considered CFIR characteristics either explicitly variations in cost or time could be influenced by how an intervention
or implicitly (Appendix B). Of those that did, 26 discussed intervention was implemented, including factors like the setting and the experience
characteristics. Oftentimes, this included discussing the strength of the of the personnel involved. Detailed implementation details are crucial as
evidence within the systematic review as well as the relative advantages they facilitate accurate interpretation of results and assist in the
of one type of SDM intervention over another. Several reviews also assessment of the intervention’s feasibility and applicability to other
considered cost comparisons between intervention types. Few system- contexts. Moreover, it allows for a better understanding of the in-
atic reviews discussed the design quality of the intervention or incor- tervention’s potential barriers to effectiveness and enables comparisons
porated information on CFIR that pertained to contextual factors within across different interventions.
and outside of the setting where the intervention was introduced. Few Our umbrella review has several limitations. First, the review is
reviews discussed the inner setting, the characteristics of individuals, or limited to only four outcomes; the literature on SDM is vast and there
the process of implementation. includes a range of additional important outcomes that we did not
incorporate, including patient satisfaction, decisional regret, and
4. Discussion and conclusion knowledge of the medical state. While this umbrella review is benefited
from the range of settings, interventions, and comparison groups found
4.1. Discussion across review articles, this variation limits generalizability and the
translation of findings. This variation may also explain why some con-
Our umbrella review found a wide range of reviews on SDM in- clusions differed across reviews. Even in reviews where the setting,
terventions. We observed that most reviews dealt with decision aids, intervention, and comparison group were similar, the year the review
though some reviewed literature across a specific type of intervention, was completed and the exclusion criteria employed may have resulted in
such as PKT interventions. There was limited evidence that SDM had moderately diverging conclusions. Morover, studies that evaluate the
clear effects on health outcomes, health care quality, cost, or consulta- effects of SDM may inappropriately equate SDM with the existence of an
tion time. However, results often ranged from neutral to positive but intervention intended to foster SDM (e.g., the existence of a decision aid
were population-specific. We observed that few reviews described the during a clinical encounter). As such, these studies may falsely infer that
context of implementation. In addition, gaps in knowledge were noted null results demonstrate a lack of SDM efficacy when, in fact, the
including the implementation climate. Reviews were low or critically intervention may not have fostered SDM. One review, for example,
low to moderate in their quality according to the AMSTAR-2 tool. evaluated SDM interventions that targeted healthcare professionals (eg.,
Across reviews that considered the effects of SDM on health out- educational meetings, educational outreach visits, and educational
comes, there were some notable benefits observed, but they were very material) and found that the current evidence is uncertain whether these
specific to the patient population. For example, there was some evidence interventions increase SDM when compared with usual care.[28] Thus,
that SDM interventions may provide some positive health benefits for the limited effects described in this umbrella review may be partially
patients with mental health conditions. Moreover, reviews generally attributed to SDM interventions that fail to foster SDM. It will be
found that SDM either reduced consultation time or did not affect important for researchers who study SDM to first examine whether the
consultation time, though there were a couple of exceptions. These interventions are fostering SDM before examining the efficacy of the

9
J.D. Bruch et al. Patient Education and Counseling 129 (2024) 108408

SDM on outcomes. [10] Smith V, Devane D, Begley CM, Clarke M. Methodology in conducting a systematic
review of systematic reviews of healthcare interventions. BMC Med Res Methodol
2011;11:15. [Link]
4.2. Conclusion [11] Aromataris E, Fernandez R, Godfrey CM, Holly C, Khalil H, Tungpunkom P.
Summarizing systematic reviews: methodological development, conduct and
reporting of an umbrella review approach. Int J Evid-Based Healthc 2015;13:
While the evidence of SDM on health outcomes, cost, health care
132–40. [Link]
quality, and consulting time remains uncertain, the effects of SDM [12] Fan J, Senthanar S, Macpherson RA, Sharpe K, Peters CE, Koehoorn M, et al. An
mostly range from neutral to positive, suggesting that SDM may remain umbrella review of the work and health impacts of working in an epidemic/
pandemic environment. Int J Environ Res Public Health 2021;18:6828. [Link]
a very promising approach in health care.
org/10.3390/ijerph18136828.
[13] Chapter 10: Umbrella reviews. JBI Manual for Evidence Synthesis. JBI; 2020.
Funding [Link]
[14] The PRISMA 2020 statement: an updated guideline for reporting systematic
reviews | The BMJ. n.d. [Link] (accessed
This research did not receive any specific grant from funding February 22, 2023).
agencies in the public, commercial, or not-for-profit sectors. [15] Gravel K, Légaré F, Graham ID. Barriers and facilitators to implementing shared
decision-making in clinical practice: a systematic review of health professionals’
perceptions. Implement Sci 2006;1:16. [Link]
CRediT authorship contribution statement [16] Covidence - Better systematic review management. Covidence. n.d. [Link]
[Link]/ (Accessed 19 October 2022).
France Légaré : Writing – review & editing, Validation, Supervision, [17] Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: a
critical appraisal tool for systematic reviews that include randomised or non-
Conceptualization. Moriah E Ellen: Writing – review & editing, Writing randomised studies of healthcare interventions, or both. BMJ 2017;358:j4008.
– original draft, Supervision, Investigation, Conceptualization. Mersiha [Link]
Mahmic-Kaknjo: Writing – review & editing, Validation, Formal anal- [18] Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering
implementation of health services research findings into practice: a consolidated
ysis. Joseph Dov Bruch: Writing – review & editing, Writing – original framework for advancing implementation science. Implement Sci 2009;4:50.
draft, Validation, Methodology, Formal analysis, Data curation. Maram [Link]
Khazen: Writing – review & editing, Investigation, Formal analysis, [19] Ross J, Stevenson F, Lau R, Murray E. Factors that influence the implementation of
e-health: a systematic review of systematic reviews (an update). Implement Sci
Data curation.
2016;11:146. [Link]
[20] Dobler CC, Sanchez M, Gionfriddo MR, Alvarez-Villalobos NA, Ospina NS, Spencer-
Declaration of Competing Interest Bonilla G, et al. The impact of decision aids used during clinical encounters on
clinician outcomes and consultation length: a systematic review. BMJ Qual Saf
2019;28:499–510. [Link]
The authors declare that they have no known competing financial [21] Marshall T, Stellick C, Abba-Aji A, Lewanczuk R, Li X-M, Olson K, et al. The impact
interests or personal relationships that could have appeared to influence of shared decision-making on the treatment of anxiety and depressive disorders:
the work reported in this paper. systematic review. BJPsych Open 2021;7:e189. [Link]
bjo.2021.1028.
[22] Fisher A, Mills K, Teesson M, Marel C. Shared decision-making among people with
Acknowledgments problematic alcohol/other drug use and co-occurring mental health conditions: a
systematic review. Drug Alcohol Rev 2021;40:307–24. [Link]
dar.13149.
None. [23] Duncan E, Best C, Hagen S. Shared decision making interventions for people with
mental health conditions. Cochrane Database Syst Rev 2010. [Link]
Registration 10.1002/14651858.CD007297.pub2.
[24] Fisher A, Manicavasagar V, Kiln F, Juraskova I. Communication and decision-
making in mental health: a systematic review focusing on Bipolar disorder. Patient
PROSPERO 2022 CRD42022343135. Educ Couns 2016;99:1106–20. [Link]
[25] Violette PD, Agoritsas T, Alexander P, Riikonen J, Santti H, Agarwal A, et al.
Decision aids for localized prostate cancer treatment choice: systematic review and
Appendix A. Supporting information meta-analysis: Prostate Cancer Treatment Choice. CA: A Cancer J Clin 2015;65:
239–51. [Link]
Supplementary data associated with this article can be found in the [26] Riddle DL, Sando T, Tarver T, Slover J, Sierra RJ, Brito JP, et al. Shared decision-
making applied to knee arthroplasty: a systematic review of randomized trials.
online version at doi:10.1016/[Link].2024.108408. Arthritis Care Res 2021;73:1125–33. [Link]
[27] Samalin L, Genty J-B, Boyer L, Lopez-Castroman J, Abbar M, Llorca P-M. Shared
References decision-making: a systematic review focusing on mood disorders. Curr Psychiatry
Rep 2018;20:23. [Link]
[28] Légaré F, Adekpedjou R, Stacey D, Turcotte S, Kryworuchko J, Graham ID, et al.
[1] Barry MJ, Edgman-Levitan S. Shared decision making–pinnacle of patient-centered
Interventions for increasing the use of shared decision making by healthcare
care. N Engl J Med 2012;366:780–1. [Link]
professionals. Cochrane Database Syst Rev 2018;2018. [Link]
[2] Baik D, Cho H, Masterson Creber RM. Examining interventions designed to support
14651858.CD006732.pub4.
shared decision making and subsequent patient outcomes in palliative care: a
[29] Saheb Kashaf M, McGill ET, Berger ZD. Shared decision-making and outcomes in
systematic review of the Literature. Am J Hosp Palliat Care 2019;36:76–88.
type 2 diabetes: a systematic review and meta-analysis. Patient Educ Couns 2017;
[Link]
100:2159–71. [Link]
[3] Légaré F, Stacey D, Pouliot S, Gauvin F-P, Desroches S, Kryworuchko J, et al.
[30] Dwamena F, Holmes-Rovner M, Gaulden CM, Jorgenson S, Sadigh G, Sikorskii A,
Interprofessionalism and shared decision-making in primary care: a stepwise
et al. Interventions for providers to promote a patient-centred approach in clinical
approach towards a new model. J Interprof Care 2011;25:18–25. [Link]
consultations. Cochrane Database Syst Rev 2012. [Link]
10.3109/13561820.2010.490502.
14651858.CD003267.pub2.
[4] Stacey D, Légaré F, Lewis KB. Patient decision aids to engage adults in treatment or
[31] Knops AM, Legemate DA, Goossens A, Bossuyt PMM, Ubbink DT. Decision aids for
screening decisions. JAMA 2017;318:657–8. [Link]
patients facing a surgical treatment decision: a systematic review and meta-
jama.2017.10289.
analysis. Ann Surg 2013;257:860–6. [Link]
[5] Stacey D, Légaré F, Lewis K, Barry MJ, Bennett CL, Eden KB, et al. Decision aids for
SLA.0b013e3182864fd6.
people facing health treatment or screening decisions. Cochrane Database Syst Rev
[32] Paskins Z, Torres Roldan VD, Hawarden AW, Bullock L, Meritxell Urtecho S,
2017;(4):CD001431. [Link]
Torres GF, et al. Quality and effectiveness of osteoporosis treatment decision aids: a
[6] Tunis SR. A clinical research strategy to support shared decision making. Health Aff
systematic review and environmental scan. Osteoporos Int 2020;31:1837–51.
2005;24:180–4. [Link]
[Link]
[7] Oshima Lee E, Emanuel EJ. Shared decision making to improve care and reduce
[33] Si J, Guo R, Lu X, Han C, Xue L, Xing D, et al. Decision aids on breast conserving
costs. N Engl J Med 2013;368:6–8. [Link]
surgery for early stage breast cancer patients: a systematic review. BMC Med
[8] Elwyn G, Laitner S, Coulter A, Walker E, Watson P, Thomson R. Implementing
Inform Decis Mak 2020;20:275. [Link]
shared decision making in the NHS. BMJ 2010;341:c5146. [Link]
[34] Malone H, Biggar S, Javadpour S, Edworthy Z, Sheaf G, Coyne I. Interventions for
10.1136/bmj.c5146.
promoting participation in shared decision-making for children and adolescents
[9] Montori VM, Kunneman M, Brito JP. Shared decision making and improving health
with cystic fibrosis. Cochrane Database Syst Rev 2019. [Link]
care: The answer is not in. JAMA 2017;318:617–8. [Link]
14651858.CD012578.pub2.
jama.2017.10168.

10
J.D. Bruch et al. Patient Education and Counseling 129 (2024) 108408

[35] Leatherman S, Warrick L. Effectiveness of decision aids. Med Care Res Rev 2008; [58] Brand PLP, Stiggelbout AM. Effective follow-up consultations: the importance of
65:79S–116S. [Link] patient-centered communication and shared decision making. Paediatr Respir Rev
[36] Sanders ARJ, van Weeghel I, Vogelaar M, Verheul W, Pieters RHM, de Wit NJ, et al. 2013;14:224–8. [Link]
Effects of improved patient participation in primary care on health-related [59] Veenendaal H van, Chernova G, Bouman CM, Etten – Jamaludin FS van, Dieren S
outcomes: a systematic review. Fam Pr 2013;30:365–78. [Link] van, Ubbink DT. Shared decision-making and the duration of medical
fampra/cmt014. consultations: a systematic review and meta-analysis. Patient Educ Couns 2023;
[37] Butterworth JE, Hays R, McDonagh STJ, Bower P, Pitchforth E, Richards SH, et al. 107:107561. [Link]
Involving older people with multimorbidity in decision-making about their [60] Hofstede SN, Marang-van de Mheen PJ, Wentink MM, Stiggelbout AM, Vleggeert-
primary healthcare: a cochrane systematic review of interventions (abridged). Lankamp CL, Vliet Vlieland TP, et al. Barriers and facilitators to implement shared
Patient Educ Couns 2020;103:2078–94. [Link] decision making in multidisciplinary sciatica care: a qualitative study. Implement
pec.2020.04.008. Sci 2013;8:95. [Link]
[38] Coronado-Vázquez V, Canet-Fajas C, Delgado-Marroquín MT, Magallón-Botaya R, [61] Institute of Medicine (US) Committee on Quality of Health Care in America.
Romero-Martín M, Gómez-Salgado J. Interventions to facilitate shared decision- Crossing the quality chasm: A new health system for the 21st Century. Washington
making using decision aids with patients in Primary Health Care: A systematic (DC): National Academies Press (US); 2001.
review. Medicine 2020;99:e21389. [Link] [62] Siebinga VY, Driever EM, Stiggelbout AM, Brand PLP. Shared decision making,
MD.0000000000021389. patient-centered communication and patient satisfaction - a cross-sectional
[39] Johnson RA, Huntley A, Hughes RA, Cramer H, Turner KM, Perkins B, et al. analysis. Patient Educ Couns 2022;105:2145–50. [Link]
Interventions to support shared decision making for hypertension: a systematic pec.2022.03.012.
review of controlled studies. Health Expect 2018;21:1191–207. [Link] [63] Scholl I, Nicolai J, Pahlke S, Kriston L, Krupat E, Härter M. The German version of
10.1111/hex.12826. the four habits coding scheme - association between physicians’ communication
[40] Karagiannis T, Andreadis P, Manolopoulos A, Malandris K, Avgerinos I, and shared decision making skills in the medical encounter. Patient Educ Couns
Karagianni A, et al. Decision aids for people with Type 2 diabetes mellitus: an 2014;94:224–9. [Link]
effectiveness rapid review and meta-analysis. Diabet Med: A J Br Diabet Assoc [64] Squires JE, Aloisio LD, Grimshaw JM, Bashir K, Dorrance K, Coughlin M, et al.
2019;36:557–68. [Link] Attributes of context relevant to healthcare professionals’ use of research evidence
[41] Harun A, Harrison JD, Young JM. Interventions to improve patient participation in in clinical practice: a multi-study analysis. Implement Sci 2019;14:52. [Link]
the treatment process for culturally and linguistically diverse people with cancer: a org/10.1186/s13012-019-0900-8.
systematic review. Asia Pac J Clin Oncol 2013;9:99–109. [Link] [65] Bruel S, Leclercq T, Ginzarly M, Botelho-Nevers E, Frappé P, Gagneux-Brunon A.
j.1743-7563.2012.01531.x. Patient decision aid in vaccination: a systematic review of the literature. Expert
[42] Sanftenberg L, Kuehne F, Anraad C, Jung-Sievers C, Dreischulte T, Gensichen J. Rev Vaccin 2020;19:305–11. [Link]
Assessing the impact of shared decision making processes on influenza vaccination [66] Clayman ML, Bylund CL, Chewning B, Makoul G. The impact of patient
rates in adult patients in outpatient care: a systematic review and meta-analysis. participation in health decisions within medical encounters: a systematic review.
Vaccine 2021;39:185–96. [Link] Med Decis Mak 2016;36:427–52. [Link]
[43] Johnson RA, Huntley A, Hughes RA, Cramer H, Turner KM, Perkins B, et al. [67] Coronado-Vázquez V, Gómez-Salgado J, Cerezo-Espinosa de los Monteros J,
Interventions to support shared decision making for hypertension: a systematic García-Colinas MA. Shared decision-support tools in hospital emergency
review of controlled studies. Health Expect 2018;21:1191–207. [Link] departments: a systematic review. J Emerg Nurs 2019;45:386–93. [Link]
10.1111/hex.12826. 10.1016/[Link].2019.01.002.
[44] Coxeter P, Del Mar CB, McGregor L, Beller EM, Hoffmann TC. Interventions to [68] Gagliardi AR, Légaré F, Brouwers MC, Webster F, Badley E, Straus S. Patient-
facilitate shared decision making to address antibiotic use for acute respiratory mediated knowledge translation (PKT) interventions for clinical encounters: a
infections in primary care. Cochrane Database Syst Rev 2015;2017. [Link] systematic review. Implement Sci 2015;11:26. [Link]
org/10.1002/14651858.CD010907.pub2. 016-0389-3.
[45] Coxeter P, Del Mar CB, McGregor L, Beller EM, Hoffmann TC. Interventions to [69] Geerse OP, Stegmann ME, Kerstjens HAM, Hiltermann TJN, Bakitas M,
facilitate shared decision making to address antibiotic use for acute respiratory Zimmermann C, et al. Effects of shared decision making on distress and health care
infections in primary care. Cochrane Database Syst Rev 2015;2017. [Link] utilization among patients with lung cancer: a systematic review. J Pain Symptom
org/10.1002/14651858.CD010907.pub2. Manag 2018;56:975–987.e5. [Link]
[46] Dwamena F, Holmes-Rovner M, Gaulden CM, Jorgenson S, Sadigh G, Sikorskii A, jpainsymman.2018.08.011.
et al. Interventions for providers to promote a patient-centred approach in clinical [70] Hauser K, Koerfer A, Kuhr K, Albus C, Herzig S, Matthes J. Outcome-relevant
consultations. Cochrane Database Syst Rev 2012. [Link] effects of shared decision making. Dtsch Arztebl Int 2015;112:665–71. [Link]
14651858.CD003267.pub2. org/10.3238/arztebl.2015.0665.
[47] Shay LA, Lafata JE. Where is the evidence? A systematic review of shared decision [71] Jain A, Corriveau S, Quinn K, Gardhouse A, Vegas DB, You JJ. Video decision aids
making and patient outcomes. Med Decis Mak: Int J Soc Med Decis Mak 2015;35: to assist with advance care planning: a systematic review and meta-analysis. BMJ
114–31. [Link] Open 2015;5:e007491. [Link]
[48] Jain A, Corriveau S, Quinn K, Gardhouse A, Vegas DB, You JJ. Video decision aids [72] Jimbo M, Rana GK, Hawley S, Holmes-Rovner M, Kelly-Blake K, Nease DE, et al.
to assist with advance care planning: a systematic review and meta-analysis. BMJ What is lacking in current decision aids on cancer screening? CA: A Cancer J Clin
Open 2015;5:e007491. [Link] 2013;63:193–214. [Link]
[49] Samalin L, Genty J-B, Boyer L, Lopez-Castroman J, Abbar M, Llorca P-M. Shared [73] Joosten E a G, DeFuentes-Merillas L, Weert GH, de, Sensky T, Staak CPF, van der,
decision-making: a systematic review focusing on mood disorders. Curr Psychiatry Jong CAJ de. Systematic review of the effects of shared decision-making on patient
Rep 2018;20:23. [Link] satisfaction, treatment adherence and health status. PPS 2008;77:219–26. https://
[50] Barnes GD, Izzo B, Conte ML, Chopra V, Holbrook A, Fagerlin A. Use of decision [Link]/10.1159/000126073.
aids for shared decision making in venous thromboembolism: a systematic review. [74] Kryworuchko J, Hill E, Murray MA, Stacey D, Fergusson DA. Interventions for
Thromb Res 2016;143:71–5. [Link] shared decision-making about life support in the intensive care unit: a systematic
[51] Stacey D, Kryworuchko J, Belkora J, Davison BJ, Durand M-A, Eden KB, et al. review: decision-making about life support. World Evid-Based Nurs 2013;10:3–16.
Coaching and guidance with patient decision aids: a review of theoretical and [Link]
empirical evidence. BMC Med Inf Decis Mak 2013;13:S11. [Link] [75] Kuehne F, Sanftenberg L, Dreischulte T, Gensichen J. Shared decision making
10.1186/1472-6947-13-S2-S11. enhances pneumococcal vaccination rates in adult patients in outpatient care. Int J
[52] Poprzeczny AJ, Stocking K, Showell M, Duffy JMN. Patient decision aids to Environ Res Public Health 2020;17:9146. [Link]
facilitate shared decision making in obstetrics and gynecology: a systematic review ijerph17239146.
and meta-analysis. Obstet Gynecol 2020;135:444–51. [Link] [76] Kuo AM-S, Thavalathil B, Elwyn G, Nemeth Z, Dang S. The promise of electronic
AOG.0000000000003664. health records to promote shared decision making: a narrative review and a look
[53] O’Connor AM, Bennett CL, Stacey D, Barry M, Col NF, Eden KB, et al. Decision aids ahead. Med Decis Mak 2018;38:1040–5. [Link]
for people facing health treatment or screening decisions. Cochrane Database Syst 0272989X18796223.
Rev 2009:CD001431. [Link] [77] Molenaar S, Sprangers MAG, Postma-Schuit FCE, Rutgers EJTh, Noorlander J,
[54] Berlin NL, Tandon VJ, Hawley ST, Hamill JB, MacEachern MP, Lee CN, et al. Hendriks J, et al. Interpretive review: feasibility and effects of decision aids. Med
Feasibility and efficacy of decision aids to improve decision making for Decis Mak 2000;20:112–27. [Link]
postmastectomy breast reconstruction: a systematic review and meta-analysis. Med [78] Scalia P, Durand M-A, Berkowitz JL, Ramesh NP, Faber MJ, Kremer JAM, et al. The
Decis Mak 2019;39:5–20. [Link] impact and utility of encounter patient decision aids: systematic review, meta-
[55] Gagliardi AR, Légaré F, Brouwers MC, Webster F, Badley E, Straus S. Patient- analysis and narrative synthesis. Patient Educ Couns 2019;102:817–41. https://
mediated knowledge translation (PKT) interventions for clinical encounters: a [Link]/10.1016/[Link].2018.12.020.
systematic review. Implement Sci 2015;11:26. [Link] [79] Shay LA, Lafata JE. Where is the evidence? A systematic review of shared decision
016-0389-3. making and patient outcomes. Med Decis Mak 2015;35:114–31. [Link]
[56] Violette PD, Agoritsas T, Alexander P, Riikonen J, Santti H, Agarwal A, et al. 10.1177/0272989X14551638.
Decision aids for localized prostate cancer treatment choice: Systematic review and [80] Stacey D, Kryworuchko J, Bennett C, Murray MA, Mullan S, Légaré F. Decision
meta-analysis: prostate cancer treatment choice. CA: A Cancer J Clin 2015;65: coaching to prepare patients for making health decisions: a systematic review of
239–51. [Link]
[57] Légaré F, Thompson-Leduc P. Twelve myths about shared decision making. Patient
Educ Couns 2014;96:281–6. [Link]

11
J.D. Bruch et al. Patient Education and Counseling 129 (2024) 108408

decision coaching in trials of patient decision AIDS. Med Decis Mak 2012;32: [82] Zisman-Ilani Y, Barnett E, Harik J, Pavlo A, O’Connell M. Expanding the concept of
E22–33. [Link] shared decision making for mental health: systematic search and scoping review of
[81] Wickramasekera N, Taylor SK, Lumley E, Gray T, Wilson E, Radley S. Can interventions. MHRJ 2017;22:191–213. [Link]
electronic assessment tools improve the process of shared decision-making? A 0002.
systematic review. Health Inf Manag 2023;52:72–86. [Link]
1833358320954385.

12