Table 3.

Barriers and Facilitators for Shared Decision Making and Their Practice Implications

CategoryPractice implications
Barrier

  • Cultural discordance

  • Language barriers

  • Health care system prioritized White patients

  • Perceived prejudice/bias/stereotypes

  • Imbalance/balance of power

  • Mistrust/suspicion in health care system

  • Clinician time/time constraints

  • Clinicians making recommendations


Facilitator

  • Cultural concordance

  • Cultural competence/humility

  • Language competence

  • Clinician honesty/full disclosure

  • Medical skills/competence

  • Clinician accessibility/availability

  • Interpersonal skills

  • Communication skills/clear communication

  • Humanistic communication: empathy, concern, compassion, courtesy

  • Partnership/participation in decision making

  • Information sharing

  • Patient encouraged to share

  • Ability to ask questions

  • Self-efficacy

  • Assertiveness/questioning authority

Health care systems can focus on hiring and retaining a workforce that can meet the cultural concordance and language concordance needs of their patient population.
Clinicians can actively work to identify, understand, and unlearn implicit bias. Resources that clinicians can leverage are available online (https://www.aafp.org/pubs/fpm/issues/2019/0700/p29.html).
Health systems can support clinicians in enabling sufficient encounter time for patients to share their stories and ask questions.
Clinicians can focus on clear, empathetic, honest, compassionate, and courteous communication.
Clinicians can engage patients in decision making by encouraging information sharing, eliciting questions from the patient, and encouraging patients to communicate their preferences.