Sex and gender considerations in implementation interventions to promote shared decision making: A secondary analysis of a Cochrane systematic review

Abstract

Background Shared decision making (SDM) in healthcare is an approach in which health professionals support patients in making decisions based on best evidence and their values and preferences. Considering sex and gender in SDM research is necessary to produce precisely-targeted interventions, improve evidence quality and redress health inequities. A first step is correct use of terms. We therefore assessed sex and gender terminology in SDM intervention studies.

Sex and Gender Considerations in Reporting Guidelines of Health Research: A Systematic Review

“…Indeed, we found a modest increased use of "sex" and "gender" over time. The earlier use of "gender" in reporting guidelines was not surprising and might be used for "sex", denoting the issues of inadequate and interchangeable use of these terms, particularly "gender", as reported elsewhere [5,19,21,22,40]. These issues should be reflected in the future development of reporting guidelines or updates of existing guidelines.…”

“…In another study that examined original investigations on diabetes, published in 2015 in the top ten general medicine and diabetes-specific journals based on impact factors, "sex" and "gender" were mentioned in the introduction section of 10% and in the methods sections of 30% [22]. More recently, "sex" was mentioned in 43% and "gender" in 41% of 87 studies (published between 1995 and 2017) included in a Cochrane review on the effectiveness of interventions for increasing the use of shared decision making by health professionals [19]. Thus, the proportion of the use of "sex" and "gender" terms in the reporting guidelines (published between 1995 and 2018) is far below that of original studies (14% versus 43% for "sex"; 18% versus 41% for "gender") even though they were published during the same time period.…”

“…In a previous review study, from which we adopted the definition of correct use (based on three criteria), no study met all three criteria [19]. Tannenbaum et al found that only 35% of Canadian clinical practice guidelines (published between 2013 and 2015 for noncommunicable health conditions) that included "sex" and/or "gender" terms used them correctly according to the Sex and Gender Equity in Research Guidelines [5].…”

“…The correct use of sex and gender was assessed by three criteria: nonbinary use, the use of appropriate categories, and noninterchangeable use of sex and gender. The three criteria are described elsewhere [19] and summarized in table 1. The use of sex and gender was correct if all three criteria were met, incorrect if at least one of three criteria was not met, and unclear if at least one of the criteria was reported as unclear and the others were met.…”

“…We performed double counting to resolve discrepancies between electronic versus manual searches. Adapted from Adisso et al [19]…”