Internal and External Influences on Shared DecisionMaking in

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

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: ü what shared decision-making is. ü 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.

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.

Inclusion Criteria • • • Participants: o Adult patients and providers involved in shared decision-making processes. Phenomena of interest: o Internal and external influences on shared decision-making o 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: o Adult patients and healthcare providers engaging in shared decision-making in all health care settings.

Methods Search strategy: • A three-step search strategy was used to identify published and unpublished qualitative research studies though November 2012.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 Info, Scopus The search for unpublished studies included: Pro.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

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

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: ü Patient-centered care, ü Bridging the knowledge gap, and ü Dimensions of decision-making.

Patient-centered Care

Bridging the Knowledge Gap

Dimensions of Decision-Making

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.

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.