Objective: Shared decision-making (SDM) as a multicollaborative approach is vital for facilitating patient-centred care. Considering the limited clinical practice, we attempted to synthesize the motivations and resistances, and investigate their mutual relationships for advancing the implementation of SDM.Methods: A comprehensive systematic review using Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines was performed. 'Shared decision making' was searched as the mesh term through PubMed, Web of Science and EBSCO from 2000 to 2021, and the quality of literature was appraised using the QualSyst Tool. Motivations and resistances were categorized based on content analysis and the 'structure-process-outcome' model.Results: From 8319 potential citations, 105 were included, comprising 53 qualitative studies (the average quality score is 0.92) and 52 quantitative studies (the average quality score is 0.95). A total of 42 categories of factors were identified into 11 themes and further grouped into three dimensions: structure, process and outcome.The structure dimension comprised six themes (71.43%), the process dimension contained four themes (11.01%) and the outcome dimension covered only one theme. Across all categories, decision-making time and patients' decision preparedness in the process dimension were the most reported, followed by physicians' communication skills and health care environment in the structure dimension.Analysis of implementation of SDM among various types of diseases showed that more influencing factors were extracted from chronic diseases and unspecified disease decisions. Conclusions:The major determinants for the implementation of SDM are focused on the structural dimension, which challenges the health systems of both developed and low-and middle-income countries. Furthermore, we consider it important to

Background: Family doctors in rural China are the main force for primary health care. It is critical to stabilize the Chinese healthcare system and improve the quality of primary health care by understanding family doctors’ turnover intention. Surface acting is an important strategy of emotional labor, and few studies have focused on the effect of emotional labor on turnover intention among family doctors. The aim of this study with Conservation of Resources theory is to explore how the surface acting of family doctors in rural areas affects turnover intention through emotional exhaustion and to investigate what role occupational commitment plays in this relationship.Methods: 953 valid data were collected by an anonymous self-administered questionnaire survey in December 2021 in Shandong Province, China. Cronbach’s α and confirmatory factor analysis (CFA) were used to estimate reliability and structural validity, respectively. The PROCESS macro in SPSS was performed to analyze mediating and moderated mediation effects of surface acting, emotional exhaustion, occupational commitment, and turnover intention.Results: Reliability and validity indicated that measurement instruments were acceptable. Surface acting had a direct positive effect on turnover intention (β= 0.481, 95%CI: [0.420, 0.543]). Emotional exhaustion partially mediated the effect of surface acting on turnover intention (indirect effect: 0.214, 95%CI: [0.175, 0.256]). Occupational commitment moderated the effect of emotional exhaustion on turnover intention (β= -0.065, 95%CI: [-0.111, -0.019]), and moderated the indirect effect of surface acting on turnover intention via emotional exhaustion (index of moderated mediation: -0.035).Conclusions: Emotional exhaustion partially mediates the relationship between surface acting and turnover intention among family doctors in rural China, and occupational commitment moderates the direct effect of emotional exhaustion on turnover intention and further moderates the mediating effect. It is suggested that engagement and diversion strategies are used to reduce the practice of surface acting. Also, pre-service education and external resources are provided to increase family doctors’ occupational commitment and minimize the incidence of emotional exhaustion and turnover intention.