A systematic review of shared decision-making interventions for people living with chronic respiratory diseases

Abstract

Introduction: Shared Decision-Making (SDM) supports patients informed and value-based decision-making. Patients with Chronic Obstructive Pulmonary Disease (COPD) express barriers accessing Pulmonary Rehabilitation (PR) perhaps exacerbated by poor decision-making. We are developing a SDM intervention to support patients’ PR decision-making. To inform this, the efficacy of SDM within Chronic Respiratory Disease (CRD) warrants exploration.

Aim: To evaluate the impact of SDM interventions upon patient decision-making (primary outcome), downstream decision outcomes (cognitive/behavioural; (secondary outcome)), and adherence to the MIND-IT model of SDM (exploratory outcome).

Method: We searched electronic databases for quantitative or mixed method randomised/non-randomised controlled trials evaluating SDM interventions in patients with CRD. We used the Cochrane Risk of Bias and GRADE tools and a narrative synthesis to evaluate the review’s objectives.

Results: Eight studies [n=1,596 (of 17,466 citations identified)] fulfilled the inclusion criteria. All primary and 3 [of 4] secondary outcomes improved post intervention. No outcome was reported consistently across studies. Three studies had high risk of bias, three had low quality of evidence. Interventions reported inconsistent adherence to the MIND-IT model of SDM (5/8 studies adhered fully).

Conclusion: There is evidence SDM interventions for patients with CRD improve patient decision-making and decision outcomes. Few interventions comply with all components of SDM and thus limit the scope for systematic evaluation of their efficacy. Further high-quality research is required (e.g., a robust, theory-driven PR SDM intervention).