OBJECTIVES

: Shared decision making (SDM) is a key component of patient-centered care and highlights the importance of the physician-patient relationship in optimizing health outcomes and reducing healthcare spending. As SDM gains prominence in oncology clinical practice, a need remains to understand the patient’s perspective in terms of disease knowledge, treatment choice, health literacy, and trust/confidence in their healthcare team. A systematic literature review of international studies (non-USA) was conducted to examine patient-related barriers and facilitators to SDM in oncology care.

METHODS

: Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, a systematic literature review of all relevant international, English-language publications from January 2007 to November 2017 was conducted searching PubMed, EBSCO Medline, CINAHL, Scopus, and Cochrane Library databases. Search terms focused on cancer, shared decision making, andphysician-patient communication RESULTS

: A total of 1150 articles were identified and, based on the inclusion/exclusion criteria, 44 international (non-USA) studies were included in the final review. Data from the 27 USA studies will be presented separately. Twelve countries contributed literature, with 22.7% (n=10) conducted in Canada, 18.2% (n=8) in the United Kingdom, and 13.6% (n=6) in South Korea. The most commonly studied cancer was breast (20; 45.5%) followed by prostate cancer (6; 13.6%). Patient perspectives were collected primarily through surveys or qualitative assessments such as focus groups/interviews. Perceived facilitators identified by patients included physician recommendations, access to medical information, and social support. Perceived barriers included paternalistic relationships, limited awareness and lack of choices in treatment decisions.

CONCLUSIONS

: This systematic review reveals a broad range of barriers and facilitators that should be addressed to promote the successful implementation of SDM in oncology care. SDM represents an opportunity for physicians, caregivers, and patients to improve outcomes and reduce costs in oncology.