Methods Covering 1990 to March 2006, PubMed, Embase, CINHAL, PsycINFO, and Dissertation Abstracts were searched for English or French language studies. The references of included studies were also consulted. Included studies reported on health professionals' perceived barriers and facilitators to implementing shared decision making in practice. Shared decision making was defined as a joint process between health professionals and patients to make decision or as decision support interventions including decision aids, or as the active participation of patients to decision making. No study design was excluded. Quality of the included studies was assessed independently by two of the authors. Using a pre-established taxonomy of barriers and facilitators to implementing clinical practice guidelines in practice, content analysis was performed.
Results 32 publications that covered 29 unique studies were included. Eleven studies were from UK, nine from US, four from Canada, two from Netherlands and one from each of the following countries: France, Mexico and Australia. Most of the studies used qualitative methods exclusively (18/29). Overall, the vast majority of participants (n=2784) were physicians (89%). The three most often reported barriers were: time constraints (18/29), lack of applicability due to patients' characteristics (13/29) and lack of applicability due to the clinical situation (12/29). The three most often reported facilitators were: providers' motivation (15/29), positive impact on the clinical process (11/29) and positive impact on patients' outcomes (10/29).
Conclusions This systematic review reveals that interventions to foster implementation of shared decision making in practice will need to address a broad range of factors. It also reveals that there is very little known about health professionals others than physicians. Future studies about implementation of shared decision making should target a more diverse group of health professionals.