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Do Interventions Designed to Support Shared Decision-Making Reduce Health Inequalities? A Systematic Review and Meta-Analysis

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  • Marie-Anne Durand
  • Lewis Carpenter
  • Hayley Dolan
  • Paulina Bravo
  • Mala Mann
  • Frances Bunn
  • Glyn Elwyn

Abstract

Background: Increasing patient engagement in healthcare has become a health policy priority. However, there has been concern that promoting supported shared decision-making could increase health inequalities. Objective: To evaluate the impact of SDM interventions on disadvantaged groups and health inequalities. Design: Systematic review and meta-analysis of randomised controlled trials and observational studies. Data Sources: CINAHL, the Cochrane Register of Controlled Trials, the Cochrane Database of Systematic Reviews, EMBASE, HMIC, MEDLINE, the NHS Economic Evaluation Database, Open SIGLE, PsycINFO and Web of Knowledge were searched from inception until June 2012. Study Eligibility Criteria: We included all studies, without language restriction, that met the following two criteria: (1) assess the effect of shared decision-making interventions on disadvantaged groups and/or health inequalities, (2) include at least 50% of people from disadvantaged groups, except if a separate analysis was conducted for this group. Results: We included 19 studies and pooled 10 in a meta-analysis. The meta-analyses showed a moderate positive effect of shared decision-making interventions on disadvantaged patients. The narrative synthesis suggested that, overall, SDM interventions increased knowledge, informed choice, participation in decision-making, decision self-efficacy, preference for collaborative decision making and reduced decisional conflict among disadvantaged patients. Further, 7 out of 19 studies compared the intervention's effect between high and low literacy groups. Overall, SDM interventions seemed to benefit disadvantaged groups (e.g. lower literacy) more than those with higher literacy, education and socioeconomic status. Interventions that were tailored to disadvantaged groups' needs appeared most effective. Conclusion: Results indicate that shared decision-making interventions significantly improve outcomes for disadvantaged patients. According to the narrative synthesis, SDM interventions may be more beneficial to disadvantaged groups than higher literacy/socioeconomic status patients. However, given the small sample sizes and variety in the intervention types, study design and quality, those findings should be interpreted with caution.

Suggested Citation

  • Marie-Anne Durand & Lewis Carpenter & Hayley Dolan & Paulina Bravo & Mala Mann & Frances Bunn & Glyn Elwyn, 2014. "Do Interventions Designed to Support Shared Decision-Making Reduce Health Inequalities? A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 9(4), pages 1-13, April.
    • Handle: RePEc:plo:pone00:0094670
    DOI: 10.1371/journal.pone.0094670
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    7. Tamara Brown & Sarah Smith & Raj Bhopal & Adetayo Kasim & Carolyn Summerbell, 2015. "Diet and Physical Activity Interventions to Prevent or Treat Obesity in South Asian Children and Adults: A Systematic Review and Meta-Analysis," IJERPH, MDPI, vol. 12(1), pages 1-29, January.
    8. Fanni Rencz & Béla Tamási & Valentin Brodszky & László Gulácsi & Miklós Weszl & Márta Péntek, 2019. "Validity and reliability of the 9-item Shared Decision Making Questionnaire (SDM-Q-9) in a national survey in Hungary," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(1), pages 43-55, June.
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    10. Joann Seo & Melody S. Goodman & Mary Politi & Melvin Blanchard & Kimberly A. Kaphingst, 2016. "Effect of Health Literacy on Decision-Making Preferences among Medically Underserved Patients," Medical Decision Making, , vol. 36(4), pages 550-556, May.
    11. Dorthe Gaby Bove & Ann‐Britt Zakrisson & Julie Midtgaard & Kirsten Lomborg & Dorthe Overgaard, 2016. "Undefined and unpredictable responsibility: a focus group study of the experiences of informal caregiver spouses of patients with severe COPD," Journal of Clinical Nursing, John Wiley & Sons, vol. 25(3-4), pages 483-493, February.
    12. Modigh, Anton & Sampaio, Filipa & Moberg, Linda & Fredriksson, Mio, 2021. "The impact of patient and public involvement in health research versus healthcare: A scoping review of reviews," Health Policy, Elsevier, vol. 125(9), pages 1208-1221.
    13. Louisa Blair & France Légaré, 2015. "Is Shared Decision Making a Utopian Dream or an Achievable Goal?," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 8(6), pages 471-476, December.

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