Internal and External Influences on Shared Decision-Making in all Health Care Settings:

1. Internal and External Influences on Shared Decision-Making in all Health Care Settings: A Qualitative Systematic Review Marie Truglio-Londrigan PhD, RN Jason T Slyer DNP, RN, FNP-BC Joanne K Singleton PhD, RN, FNP-BC Priscilla S Worral PhD, RN Eastern Nursing Research Society April 16, 2015

2. Background • The aim of shared decision-making is for patients to be active, engaged and to share in decisions pertaining to their care. • There are internal and external influences that encourage, support, and sustain the shared decision-making process. • There is a need to understand: • what shared decision-making is. • how it takes place. • These influences may be significant for the successful development and implement of patient specific practice-based strategies that may foster shared decision-making.

3. Purpose To synthesize the best available evidence related to internal and external influences on shared decision-making for adult patients and healthcare providers in all health care settings.

4. Inclusion Criteria • Participants: • Adult patients and providers involved in shared decision-making processes. • Phenomena of interest: • Internal and external influences on shared decision-making • Shared decision-making is defined as a joint process characterized by sharing and negotiating between the patient and provider that results in a mutually agreed upon decision. • Context: • Adult patients and healthcare providers engaging in shared decision-making in all health care settings.

5. Methods Search strategy: • A three-step search strategy was used to identify published and unpublished qualitative research studies though November 2012. • The databases searched included: PubMed, CINAHL, EMBASE, Healthsource: Nursing/Academic Edition, PsychInfo, Scopus • The search for unpublished studies included: ProQuest Dissertations and Theses Database, MEDNAR, Virginia Henderson International Nursing Library, New York Academy of Medicine • Keywords: Qualitative research, qualitative, decision making, shared decision making, shared decision*, shared medical decision, physician patient communication, patient provider communication, patient participation, influence*, factor*, view*

6. Methods • Methodological Quality: • Papers were reviewed for methodological quality using the Qualitative Assessment and Review (QARI) instrument from the Joanna Briggs Institute • Date collection: • Data was extracted using the Joanna Briggs Institute’s QARI Data Extraction tool. • Data Synthesis: • Data were synthesized using the Joanna Briggs Institute approach to meta-synthesis using the QARI software package.

7. Results • This systematic review identifies internal and external influences that facilitated shared decision-making. • Eight studies were included in this review. • From these studies, 61 findings were aggregated into 11 categories on the basis of similarity of meaning. • These categories yielded three synthesized findings: • Patient-centered care, • Bridging the knowledge gap, and • Dimensions of decision-making.

8. Patient-centered Care

9. Bridging the Knowledge Gap

10. Dimensions of Decision-Making

11. Healthcare Organization Commitment • Educational programs to enhance healthcare providers’ competencies and skills with regard to shared decision-making, relationship development, communication, diversity of assessments, reflective practice, ethical knowing, and negotiation. • Availability of consultation. • Exploration of decision-making models that “fit” organizational practice.

12. References Truglio-Londrigan, M., Slyer, J. T., Singleton, J. K., & Worral, P. S. (2014). A qualitative systematic review of internal and external influences on shared decision-making in all health care settings. JBI Database of Systematic Reviews and Implementation Reports. 12(5), 121-194.