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

Summary

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.

Related articles

• Shoulder Trauma and Hypomobility

  This chapter focuses on the optimal functioning of the shoulder and arm, discussing the anatomy, biomechanics, and rehabilitation principles for managing shoulder injuries. It emphasizes the importance of understanding both normal and abnormal shoulder function to enhance recovery and rehabilitation outcomes.

• Small Bowel Post Endoscopy Approach

  This document discusses the approach to diagnosing and treating patients with small bowel disorders, particularly following endoscopic procedures. It explores the physiology, common causes of symptoms, and diagnostic methods for conditions affecting the small intestine.

• COMMUNITY HEALTH NURSING

  This document discusses various aspects of community health nursing, covering topics such as health promotion, maternal and child health, mental health, and public health nursing principles. It emphasizes the importance of nursing practice in community settings and provides insight into relevant legislation and health care delivery systems.

• The Personal Health Inventory

  This document provides a comprehensive overview of the Personal Health Inventory, emphasizing health-related fitness, barriers to physical activity participation, and actionable strategies for goal-setting and overcoming obstacles to exercise.

• Anatomy of an Illness: As Perceived by the Patient - Reflections on Healing and Regeneration

  This book narrates Norman Cousins' personal fight against a crippling disease and illustrates the collaboration between a patient and his physician in overcoming illness through the power of laughter, courage, and tenacity, emphasizing the patient's role in their own recovery.