Patients’ and healthcare professionals’ perceived facilitators and barriers for shared decision-making for frail and elderly patients in perioperative care: A scoping review

Abstract

BACKGROUND: Shared decision-making (SDM) in perioperative care, an organizational approach to instituting sharing of information and decision-making around surgery, aims at enabling patient-centric treatment and alignment of care to individual patient needs. Frail and elderly patients suffering from multiple health conditions and increased surgical vulnerability require individualized healthcare and may benefit. However, little is known about the facilitators and barriers to implementing SDM in perioperative care for the specific needs of frail and elderly patients. Our objective is twofold: First, we aim at collecting and communicating facilitators and barriers. Second, we aim at collecting conceptual approaches and methods employed in determining and analyzing these facilitators and barriers. METHODS: The search strategy focused on peer-reviewed studies. We employed a taxonomy which is based on the SPIDER framework and added the items general article information, stakeholder, barriers/facilitators, category, subcategory, and setting/contextual information. This taxonomy is based on preceding studies. The scoping review is reported under the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews. Based on the databases MEDLINE, Embase, CINAHL, and Web of Science, we identified and reviewed 13 original studies. RESULTS: The major result is that patients want to be informed on their medical condition and procedures. The results further indicate that patients prefer sharing decisions over taking decisions on their own or physician induced decision-making. Communication barriers and asymmetric power relationships between patients and clinical healthcare professionals are barriers to SDM. Regarding the methodological approaches, the evaluation demonstrates that the selected articles are primarily concerned with the collection of determinants that enable or impede the implementation of SDM. These approaches lack employing a distinct theoretical framework for explaining these determinants. Second, the selected studies mainly used surveys and interviews, ethnographic studies are absent. CONCLUSION: Diverging findings perceived by patients or clinical healthcare professionals were identified. These imply that SDM research related to elderly and frail patients should become more encompassing by employing research that incorporates theory-based qualitative analysis, and ethnographic studies of SDM consultations for understanding practices by patients and clinical healthcare professionals. Ethnographic studies are particularly relevant as these were not conducted. REGISTRATION: https://osf.io/8fjnb/