EoE Module 11 References-Gravel et al Implement Sci 2006 Barriers and facilitators to implement SDM in clinical practice A systematic review

Gravel et al Implement Sci 2006 Barriers and facilitators to implement SDM in clinical practice A systematic review

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The systematic review conducted by Gravel, Légaré, and Graham examines the barriers and facilitators experienced by health professionals when implementing shared decision-making (SDM) in clinical practice. Despite SDM being promoted for enhancing patient outcomes and decision-making processes, it has not been widely adopted by health professionals.<br /><br />The review includes studies from 1990 to March 2006, searching databases such as PubMed and Embase, and focuses on health professionals' perceptions of SDM barriers and facilitators. SDM is defined as a collaborative process between patients and health professionals to make informed decisions or as interventions like decision aids that encourage patient participation.<br /><br />The study incorporated findings from 31 publications covering 28 unique studies from countries like the UK, USA, and Canada, with 89% of the 2784 participants being physicians.<br /><br />Key barriers identified include time constraints, lack of applicability due to patient characteristics or clinical situations, and perceived patient preferences that misalign with SDM models. Conversely, facilitators include the motivation of health professionals, perceived positive impacts on clinical processes, and patient outcomes.<br /><br />The review highlights the need for interventions targeting these barriers to effectively implement SDM in clinical practice. It also notes the limited representation of health professionals other than physicians in existing studies and calls for future research on diverse health professional groups. Additionally, the results emphasize the importance of training health professionals to overcome unfamiliarity and self-efficacy issues related to SDM.<br /><br />Overall, the review suggests focusing on factors that might facilitate implementation and understanding cross-cultural and healthcare system influences on SDM's adoption in clinical settings.

Keywords

shared decision-making

health professionals

barriers

facilitators

clinical practice

patient outcomes

systematic review

interventions

training

cross-cultural influences