Barriers and facilitators to implementation of shared decision-making

Abstract

Abstract The expanded availability of health information, the consumer movement, the desire of patients to be actively involved in their health care, the need to manage public expectations, and the increased concern about patient safety are among the factors that support the idea of an extended role for patients in clinical decision-making. However, shared decision-making has not yet been adopted by health practitioners. Although there are very few data available on specific interventions found to be effective for implementing shared decision-making in clinical practice, a growing body of knowledge can inform us about those interventions most likely to be successful or worth considering in future initiatives. In this chapter, we highlight the specific challenges associated with the barriers and facilitators to the adoption of shared decision-making in clinical practice. The first section reports on a conceptual model for assessing the barriers and facilitators. It then addresses measurement issues and presents a few instruments that could be useful for assessing barriers and facilitators to the implementation of shared decision-making. The second section briefly reports on implementation studies of shared decision-making in clinical practice. The last section identifies strengths and limitations associated with a barriers and facilitators assessment approach as well as areas needing further research.