Do interventions designed to support shared decision-making reduce health inequalities? A systematic review and meta-analysis.

<h4>Background</h4>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.<h4>Objective</h4>To evaluate the impact of SDM interventions...

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Autores principales:	Marie-Anne Durand, Lewis Carpenter, Hayley Dolan, Paulina Bravo, Mala Mann, Frances Bunn, Glyn Elwyn
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2014
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/a5849b406e67458580f6ab787de37a43
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spelling	oai:doaj.org-article:a5849b406e67458580f6ab787de37a432021-11-18T08:23:17ZDo interventions designed to support shared decision-making reduce health inequalities? A systematic review and meta-analysis.1932-620310.1371/journal.pone.0094670https://doaj.org/article/a5849b406e67458580f6ab787de37a432014-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24736389/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>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.<h4>Objective</h4>To evaluate the impact of SDM interventions on disadvantaged groups and health inequalities.<h4>Design</h4>Systematic review and meta-analysis of randomised controlled trials and observational studies.<h4>Data sources</h4>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.<h4>Study eligibility criteria</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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.Marie-Anne DurandLewis CarpenterHayley DolanPaulina BravoMala MannFrances BunnGlyn ElwynPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 4, p e94670 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Marie-Anne Durand Lewis Carpenter Hayley Dolan Paulina Bravo Mala Mann Frances Bunn Glyn Elwyn Do interventions designed to support shared decision-making reduce health inequalities? A systematic review and meta-analysis.
description	<h4>Background</h4>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.<h4>Objective</h4>To evaluate the impact of SDM interventions on disadvantaged groups and health inequalities.<h4>Design</h4>Systematic review and meta-analysis of randomised controlled trials and observational studies.<h4>Data sources</h4>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.<h4>Study eligibility criteria</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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.
format	article
author	Marie-Anne Durand Lewis Carpenter Hayley Dolan Paulina Bravo Mala Mann Frances Bunn Glyn Elwyn
author_facet	Marie-Anne Durand Lewis Carpenter Hayley Dolan Paulina Bravo Mala Mann Frances Bunn Glyn Elwyn
author_sort	Marie-Anne Durand
title	Do interventions designed to support shared decision-making reduce health inequalities? A systematic review and meta-analysis.
title_short	Do interventions designed to support shared decision-making reduce health inequalities? A systematic review and meta-analysis.
title_full	Do interventions designed to support shared decision-making reduce health inequalities? A systematic review and meta-analysis.
title_fullStr	Do interventions designed to support shared decision-making reduce health inequalities? A systematic review and meta-analysis.
title_full_unstemmed	Do interventions designed to support shared decision-making reduce health inequalities? A systematic review and meta-analysis.
title_sort	do interventions designed to support shared decision-making reduce health inequalities? a systematic review and meta-analysis.
publisher	Public Library of Science (PLoS)
publishDate	2014
url	https://doaj.org/article/a5849b406e67458580f6ab787de37a43
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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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