OBJECTIVES: Shared decision making (SDM) is seen as the pinnacle of patient-centered care and is increasingly advocated as an ideal model of treatment decision-making. However, SDM implementation in clinical practice remains low. Understanding factors that impede or facilitate the use of SDM will provide insights into its further implementation. This study aimed to synthesize the available evidence on barriers and facilitators to SDM.

METHODS: An umbrella review was performed using PUBMED. We included systematically conducted reviews, written in English, and published as full-text peer-reviewed journal articles that reported stakeholders’ perspectives on barriers and facilitators to SDM.

RESULTS: Of the 14 identified articles, 10 articles met the eligibility criteria. A range of key cultural (perception that patients do not want to participate in decision-making, perception that ‘doctor knows best’ and patients have ‘inferior’ knowledge), financial (lack of resources), organizational (lack of interprofessional team, busy or noisy ward, lack of training and time) and methodological (bad therapeutic relationship between patients and clinicians, poor communication skills and use of medical terminology) barriers were identified. Key themes for facilitators of SDM included cultural (recognizing there are two experts in the clinical encounter, patients accepting responsibility to be involved in decision-making), organizational (supportive policy and training of clinicians), and methodological (agreement that SDM will lead to improved health outcomes, trust and therapeutic relationship with clinician, good communication skills) factors.

CONCLUSIONS: There are diverse cultural, financial, organizational, and methodological barriers that hamper systematic implementation of SDM. However, most barriers are modifiable and can be addressed by attitudinal changes at the level of the patient, clinician/healthcare team, and the organization. Therefore, a multi-stakeholder concerted approach, as well as implementation research and policy efforts involving both patients and clinicians as research partners are needed.