Interventions to improve participation in health‐care decisions in non‐Western countries: A systematic review and narrative synthesis

Abstract

BackgroundPatients' participation in medical decision making is an important aspect of patient‐centred care. However, there is often uncertainty about its applicability and feasibility in non‐Western countries.ObjectiveTo provide an overview and assessment of interventions that aimed to improve patients' participation in decision making in non‐Western countries.MethodOvid Medline, Embase, Cochrane Central Register of Controlled Trials, CINAHL, Ovid MEDLINE(R) Epub Ahead of Print, In‐Process, Other Non‐Indexed Citations, without Revisions and Daily Update and Database of Abstracts of Reviews of Effects, were searched from respective inception to February 2018. Studies were included if they (a) were randomized controlled trials, before‐and‐after studies and interrupted time series studies; (b) were conducted in non‐Western countries; (c) aimed to improve patients' participation in dyadic decision making; and (d) reported outcomes relevant to patient participation in decision making. Studies were excluded if they included children, were about triadic decision making or solely focused on information provision without reporting outcomes related to patient participation. Narrative synthesis method was used for data analysis and presentation.ResultsA total of 17 studies, 6 RCTs and 11 non‐RCTs, were included across ten countries. Intervention strategies included patient and/or provider communication skills training, decision aids and a question prompt material. Whilst most of the studies reported increased patient participation, those interventions which had provider or patient training in communication skills were found to be more effective.ConclusionInterventions to improve patient participation, within the context of dyadic decision making, in non‐Western countries can be feasible and effective if communication skills training is provided for health‐care providers and/or patients.

Continuing professional education of Iranian healthcare professionals in shared decision-making: lessons learned

“…Third (aim 3), participants mentioned training (of both healthcare professionals and patients) and their motivation as facilitators to performing SDM, and their limited knowledge about SDM and lack of patient SDM education as barriers of practicing SDM in their clinical practice. These results are aligned with those of a recent systematic review on patient's involvement in decision-making in non-western countries that highlighted the need for healthcare professional and patient training in SDM [7]. Patients lack of familiarity with their rights and their low health literacy were acknowledged as barriers in other Iranian studies, as well [23,26].…”

“…Healthcare professionals' implementation of SDM in their practice has been slow [4]. With respect to non-western countries, a systematic review showed that patient participation in decision making can be feasible and effective, provided healthcare professionals receive training [7]. However, very little training is provided.…”

Preference for shared decision-making among Arabic-speaking people with chronic diseases: a cross-sectional study

“…These are fundamental to promote patient active participation in healthcare decisions. 55 Future research could focus on developing culturally appropriate decision aids among Arabic-speaking population and evaluating the impact of such tools on improving the extent of SDM. Additionally, to foster SDM in the country, in-depth exploration of physicians’ perspectives is needed.…”

A Multinational Study of Patient Preferences for How Decisions Are Made in Their Care

“…Although beyond the scope of this project, our findings suggest that participants in Hong Kong and Philippines may see themselves as less active participants, perhaps lower status, where they are primarily given information by the doctor and are, hopefully, asked questions to contribute to the consultation. Dolan et al (2019) highlighted that communication skills training for patients and providers from countries where participation is less active can increase patient participation and involvement in health care decisions. However, even with coaching, Kim et al (2003) found that patients felt it was important that explicit permission or endorsement be given by providers for patients to speak up and ask questions.…”