Views of stakeholders on factors influencing shared decision-making in the Eastern Mediterranean Region: a systematic review

Abstract

Background: Shared decision-making (SDM) is advocated as a key component of patient-centred care and associated with many benefits that improve patient outcomes. However, SDM is not yet embedded in clinical practice and confronts many barriers that hinder its implementation especially in countries of the World Health Organization (WHO) Eastern Mediterranean Region. Aims: We conducted a systematic review to identify and understand factors influencing SDM in the Region. Methods: We searched PsycINFO, CINAHL, PubMed, Medline, Scopus and Saudi Digital Library for articles published between 1997 and February 2019. Studies conducted in the Region that reported barriers, facilitators, experiences, expectations and attitudes to SDM were included. The Mixed Methods Appraisal Tool (MMAT) was used to assess the methodological quality of the studies in this review. Results: Of the 1812 initial articles retrieved, 18 eligible articles were identified. The main factors that emerged were grouped under 3 broad themes: participant factors (patients/families and physicians); consultation factors (relationship between participants, engaging patients, evaluating preferences, introducing options, providing information, and decision making); and healthcare system factors (organizational characteristics, time constraints, continuity of care, and healthcare resources). Conclusions: There is growing interest in SDM in several countries in the Region. However, there are many existing barriers that hinder the implementation of SDM. These need to be addressed before SDM can be fully adopted in these countries.

Healthcare professionals' views on factors influencing shared decision‐making in primary health care centres in Saudi Arabia: A qualitative study

“…To ensure that there were no language barriers, the interviews were conducted in Arabic, which is the native language of Saudis. Based on a previous literature review 30,34 of this topic, the interview schedule was developed, and piloted on two participants (who were excluded from analysis). Openended questions were used to elicit the participants' perspectives on SDM, as well as the barriers and facilitators to implementing it (see Appendix 1, Supplementary material 1 and Supplementary material 2).…”

“…Although interest in SDM is increasing, and there is a growing demand for its adoption in primary care, 14 it is still not widely used by health professionals in their daily practice 27,28 . SDM confronts many barriers that hinder its implementation especially in non‐Western countries 29,30 . This raises the questions of the reasons behind the delay in practising SDM in these countries, and factors that impede or facilitate its implementation.…”

“…There may be other barriers to SDM at the level of individuals, culture, environment and organizations that need to be identified and addressed. Only a few studies have been published to assess physicians and patients' preferences and attitudes toward SDM in Saudi Arabia, and none have studied issues related to SDM implementation 30 . The purpose of this study is to describe the perspectives of healthcare professionals regarding the implementation of SDMs in PHCCs in Saudi Arabia.…”

“…27,28 SDM confronts many barriers that hinder its implementation especially in non-Western countries. 29,30 This raises the questions of the reasons behind the delay in practising SDM in these countries, and factors that impede or facilitate its implementation. Saudi Health sector is moving toward a patient centred care approach.…”

“…Only a few studies have been published to assess physicians and patients' preferences and attitudes toward SDM in Saudi Arabia, and none have studied issues related to SDM implementation. 30 The purpose of this study is to describe the perspectives of healthcare professionals regarding the implementation of SDMs in PHCCs in Saudi Arabia. In particular, we explore the perspectives of physicians, PHCC managers, medical directors and training directors.…”