gms | German Medical Science

16. Deutscher Kongress für Versorgungsforschung

Deutsches Netzwerk Versorgungsforschung e. V.

4. - 6. Oktober 2017, Berlin

Organizational- and system-level factors that influence the implementation of shared decision-making – a scoping review

Meeting Abstract

  • Isabelle Scholl - Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Dartmouth College, Dartmouth, United States
  • Allison LaRussa - Dartmouth College, Dartmouth, United States
  • Pola Hahlweg - Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
  • Sarah Kobrin - National Cancer Institute, Bethesda, United States
  • Glyn Elwyn - Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany

16. Deutscher Kongress für Versorgungsforschung (DKVF). Berlin, 04.-06.10.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocP046

doi: 10.3205/17dkvf306, urn:nbn:de:0183-17dkvf3068

Veröffentlicht: 26. September 2017

© 2017 Scholl et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe



Background: Shared decision-making (SDM) is poorly implemented in routine care, despite its inclusion in many clinical practice guidelines and health policy. To date, no studies have synthesized the literature around organizational- and system-level factors that influence the implementation of SDM in routine care. Such a synthesis would be important, allowing exploration of potential interventions addressing these factors.

Aims: The aim of this study is to compile a comprehensive overview on organizational-level factors (i.e. characteristics of a healthcare organization) and system-level factors (i.e. characteristics of a healthcare system) that influence the implementation of SDM in routine care.

Method: We conducted a scoping review using the Arksey & O’Malley framework: 1) identifying the research question, 2) identifying relevant studies, 3) selecting studies, 4) charting the data, and 5) collating, summarizing and reporting results. The search strategy included an electronic search in three databases (Pubmed, Web of Science, CINAHL). We included publications in English and German that reported on a project or study that aimed to promote implementation of SDM or other decision support interventions in routine health care. Titles and abstracts were screened and full texts were assessed for eligibility by the review team. An ongoing secondary search includes books, grey literature, and reference tracking of key publications.

Results: After screening 7,624 records and assessing 275 full texts for eligibility, 29 publications on 24 distinct implementation projects were included and subject to data extraction. Most of the implementation projects (N=16) were conducted in the US. Nineteen projects focused on the implementation of SDM through decision aids or other forms of decision support (e.g. via phone) and 5 had a broader focus on implementing SDM in routine practice. Several organizational-level factors were described to influence the implementation of SDM in the different studies. They comprise organizational leadership, culture, resources, and priorities, as well as teams and networks, and workflows. System-level factors identified to influence the implementation of SDM in routine care included aspects of incentivization, policies, and guidelines. Some of the included papers discussed approaches to changing identified organizational- and system-level factors, including reorganization of workflows, implementation of multidisciplinary teams, a push for culture change, a push for new legislation, as well as financial incentives. Secondary search results will be available at the time of the conference.

Discussion: A broad range of organizational- and system-level characteristics are found to influence implementation of SDM in routine care. However, more work is needed to undertake a gap analysis in the identified characteristics and to evaluate the impact of potential interventions.

Practice implications: Health care organizations that plan to implement SDM should carefully consider the role of organizational-level characteristics that promote or impede implementation. Using implementation and organizational theory could be a useful way of complementing and addressing the identified factors. Health policy could foster SDM implementation by designing legislation that supports the use of a SDM process, as well as by expediting payment reforms that incentivize SDM performance.