Supportive Care in Cancer

, Volume 27, Issue 5, pp 1613–1637 | Cite as

Barriers and facilitators to shared decision-making in oncology: a systematic review of the literature

  • Jordan R. CovveyEmail author
  • Khalid M. Kamal
  • Erin E. Gorse
  • Zumi Mehta
  • Trupti Dhumal
  • Elham Heidari
  • Deepika Rao
  • Christopher Zacker
Review Article



Shared decision-making (SDM) is a strategy to facilitate patient-centered care and is increasingly important in oncology, where patients are faced with complicated treatment decisions that require them to weigh efficacy and safety, quality of life, and cost. Understanding the contributors to the use of SDM may provide insight to its further implementation. Therefore, the objective of the study was to examine the patient-related barriers/facilitators to SDM in oncology care.


A systematic literature review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was executed. A search strategy composed of cancer, decision-making, and patient-centered terms was conducted utilizing PubMed, EBSCO MEDLINE, Scopus, CINAHL, and the Cochrane Library databases between January 2007 and November 2017. Full-text, US-based, English language articles describing the patient perspective of SDM in oncology care were included. Relevant data from articles were reviewed in a qualitative synthesis.


From 3435 potential citations, a total of 35 articles were included. The most common cancers studied were breast (n = 22; 62.9%) and prostate (n = 9; 25.7%). The identified themes for barriers to SDM were uncertainty in the treatment decision, concern regarding adverse effects, and poor physician communication. Themes for facilitators for SDM included physician consideration of patient preferences, positive physician actions and behaviors, and use or encouragement of support systems.


As SDM gains use within oncology practice, understanding key influences will allow for more effective implementation of strategies to increase patient engagement and improve care and value in the treatment process.


Neoplasms Patient-centered care Patient participation Communication barriers 



The authors thank David Nolfi, MLS, for his assistance in creating the search strategy for this review. The authors also thank Margaret English, Benjamin Lackner, Jonathan Kloss, Valerie Magda, and Cecelia Trybus for their assistance in executing this project.

Statement of funding source and role of sponsor

This study was funded by the Novartis Pharmaceuticals Corporation, who provided the concept, general oversight, and research collaboration on the project.

Compliance with ethical standards

Conflict of interest

Covvey and Kamal have received research funding from Novartis Pharmaceuticals Corporation and the College of Psychiatric and Neurologic Pharmacists. Rao has received funding from the College of Psychiatric and Neurologic Pharmacists for an unrelated project. Zacker is employed by Novartis Pharmaceuticals Corporation. Gorse was employed by AbbVie through an internship at the time of writing.


  1. 1.
    Elwyn G, Laitner S, Coulter A, Walker E, Watson P, Thomson R (2010) Implementing shared decision making in the NHS. BMJ 341:c5146CrossRefPubMedGoogle Scholar
  2. 2.
    Barry MJ, Edgman-Levitan S (2012) Shared decision making—pinnacle of patient-centered care. N Engl J Med 366(9):780–781CrossRefPubMedGoogle Scholar
  3. 3.
    IOM (Institute of Medicine) (2013) Delivering high-quality cancer care: charting a new course for a system in crisis. The National Academies Press, Washington, DCGoogle Scholar
  4. 4.
    Stacey D, Legare F, Lewis K et al (2017) Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 4:CD001431PubMedGoogle Scholar
  5. 5.
    National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) with NCCN Evidence Blocks™. Accessed 7/3/2018
  6. 6.
    Centers for Medicare & Medicaid Services. Oncology care model. Accessed 7/3/2018
  7. 7.
    Millenson ML, Berenson RA (2017) Shared decisions in cancer care: is Medicare providing a model? Accessed 7/3/2018
  8. 8.
    Waldeck AR, Botteman MF, White RE, van Hout BA (2017) The importance of economic perspective and quantitative approaches in oncology value frameworks of drug selection and shared decision making. J Manag Care Spec Pharm 23(6-a Suppl):S6–S12PubMedGoogle Scholar
  9. 9.
    Frerichs W, Hahlweg P, Muller E, Adis C, Scholl I (2016) Shared decision-making in oncology—a qualitative analysis of healthcare providers’ views on current practice. PLoS One 11(3):e0149789CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Muller E, Hahlweg P, Scholl I (2016) What do stakeholders need to implement shared decision making in routine cancer care? A qualitative needs assessment. Acta Oncol 55(12):1484–1491CrossRefPubMedGoogle Scholar
  11. 11.
    Coyne I, O’Mathuna DP, Gibson F, Shields L, Leclercq E, Sheaf G (2016) Interventions for promoting participation in shared decision-making for children with cancer. Cochrane Database Syst Rev 11:CD008970PubMedGoogle Scholar
  12. 12.
    Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Transparent reporting of systematic reviews and meta-analyses. Accessed 6/22/2018
  13. 13.
    Henrikson NB, Ellis WJ, Berry DL (2009) “It’s not like I can change my mind later”: reversibility and decision timing in prostate cancer treatment decision-making. Patient Educ Couns 77(2):302–307CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Lally RM (2009) In the moment: women speak about surgical treatment decision making days after a breast cancer diagnosis. Oncol Nurs Forum 36(5):E257–E265CrossRefPubMedGoogle Scholar
  15. 15.
    Arora NK, Gustafson DH (2009) Perceived helpfulness of physicians’ communication behavior and breast cancer patients’ level of trust over time. J Gen Intern Med 24(2):252–255CrossRefPubMedGoogle Scholar
  16. 16.
    Shuman AG, Larkin K, Thomas D, Palmer FL, Fins JJ, Baxi SS, Lee N, Shah JP, Fagerlin A, Patel SG (2017) Patient reflections on decision making for laryngeal cancer treatment. Otolaryngol Head Neck Surg 156(2):299–304CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Brufsky AM, Ormerod C, Bell Dickson R, Citron ML (2017) Understanding the needs of patients with metastatic breast cancer: results of the make your dialogue count survey. Breast J 23(1):17–25CrossRefPubMedGoogle Scholar
  18. 18.
    Martinez KA, Resnicow K, Williams GC, Silva M, Abrahamse P, Shumway DA, Wallner LP, Katz SJ, Hawley ST (2016) Does physician communication style impact patient report of decision quality for breast cancer treatment? Patient Educ Couns 99(12):1947–1954CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Lee SC, Marks EG, Sanders JM, Wiebe DJ (2016) Elucidating patient-perceived role in “decision-making” among African Americans receiving lung cancer care through a county safety-net system. J Cancer Surviv 10(1):153–163CrossRefPubMedGoogle Scholar
  20. 20.
    Parker PA, Peterson SK, Bedrosian I, Crosby MA, Shen Y, Black DM, Babiera G, Kuerer HM, Ying J, Dong W, Cantor SB, Brewster AM (2016) Prospective study of surgical decision-making processes for contralateral prophylactic mastectomy in women with breast cancer. Ann Surg 263(1):178–183CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Colley A, Halpern J, Paul S, Micco G, Lahiff M, Wright F, Levine JD, Mastick J, Hammer MJ, Miaskowski C, Dunn LB (2017) Factors associated with oncology patients’ involvement in shared decision making during chemotherapy. Psychooncology 26(11):1972–1979CrossRefPubMedGoogle Scholar
  22. 22.
    Shabason JE, Mao JJ, Frankel ES, Vapiwala N (2014) Shared decision-making and patient control in radiation oncology: implications for patient satisfaction. Cancer 120(12):1863–1870CrossRefPubMedGoogle Scholar
  23. 23.
    Chhabra KR, Pollak KI, Lee SJ, Back AL, Goldman RE, Tulsky JA (2013) Physician communication styles in initial consultations for hematological cancer. Patient Educ Couns 93(3):573–578CrossRefPubMedGoogle Scholar
  24. 24.
    King L, O’Neill SC, Spellman E, Peshkin BN, Valdimarsdottir H, Willey S, Leventhal KG, DeMarco T, Nusbaum R, Feldman E, Jandorf L, Schwartz MD (2013) Intentions for bilateral mastectomy among newly diagnosed breast cancer patients. J Surg Oncol 107(7):772–776CrossRefPubMedGoogle Scholar
  25. 25.
    Shelton RC, Clarke Hillyer G, Hershman DL et al (2013) Interpersonal influences and attitudes about adjuvant therapy treatment decisions among non-metastatic breast cancer patients: an examination of differences by age and race/ethnicity in the BQUAL study. Breast Cancer Res Treat 137(3):817–828CrossRefPubMedGoogle Scholar
  26. 26.
    Song L, Chen RC, Bensen JT, Knafl GJ, Nielsen ME, Farnan L, Wallen EM, Mishel M, Pruthi RS, Mohler JL, Godley PA (2013) Who makes the decision regarding the treatment of clinically localized prostate cancer—the patient or physician?: results from a population-based study. Cancer 119(2):421–428CrossRefGoogle Scholar
  27. 27.
    Alexander SC, Sullivan AM, Back AL, Tulsky JA, Goldman RE, Block SD, Stewart SK, Wilson-Genderson M, Lee SJ (2012) Information giving and receiving in hematological malignancy consultations. Psychooncology 21(3):297–306CrossRefPubMedGoogle Scholar
  28. 28.
    Pieters HC, Heilemann MV, Maliski S, Dornig K, Mentes J (2012) Instrumental relating and treatment decision making among older women with early-stage breast cancer. Oncol Nurs Forum 39(1):E10–E19CrossRefPubMedGoogle Scholar
  29. 29.
    Sidana A, Hernandez DJ, Feng Z, Partin AW, Trock BJ, Saha S, Epstein JI (2012) Treatment decision-making for localized prostate cancer: what younger men choose and why. Prostate 72(1):58–64CrossRefPubMedGoogle Scholar
  30. 30.
    Nelson JE, Gay EB, Berman AR, Powell CA, Salazar-Schicchi J, Wisnivesky JP (2011) Patients rate physician communication about lung cancer. Cancer 117(22):5212–5220CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Xu J, Dailey RK, Eggly S, Neale AV, Schwartz KL (2011) Men’s perspectives on selecting their prostate cancer treatment. J Natl Med Assoc 103(6):468–478CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Politi MC, Clark MA, Ombao H, Dizon D, Elwyn G (2011) Communicating uncertainty can lead to less decision satisfaction: a necessary cost of involving patients in shared decision making? Health Expect 14(1):84–91CrossRefPubMedGoogle Scholar
  33. 33.
    Sheppard VB, Williams KP, Harrison TM, Jennings Y, Lucas W, Stephen J, Robinson D, Mandelblatt JS, Taylor KL (2010) Development of decision-support intervention for black women with breast cancer. Psychooncology 19(1):62–70CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Orom H, Biddle C, Underwood W 3rd, Nelson CJ, Homish DL (2016) What is a “good” treatment decision? Decisional control, knowledge, treatment decision making, and quality of life in men with clinically localized prostate cancer. Med Decis Mak 36(6):714–725CrossRefGoogle Scholar
  35. 35.
    Schubart JR, Farnan MA, Kass RB (2015) Breast cancer surgery decision-making and African-American women. J Cancer Educ 30(3):497–502CrossRefPubMedGoogle Scholar
  36. 36.
    Walsh MC, Trentham-Dietz A, Schroepfer TA, Reding DJ, Campbell B, Foote ML, Kaufman S, Barrett M, Remington PL, Cleary JF (2010) Cancer information sources used by patients to inform and influence treatment decisions. J Health Commun 15(4):445–463CrossRefPubMedGoogle Scholar
  37. 37.
    Kahn KL, Schneider EC, Malin JL, Adams JL, Epstein AM (2007) Patient centered experiences in breast cancer: predicting long-term adherence to tamoxifen use. Med Care 45(5):431–439CrossRefPubMedGoogle Scholar
  38. 38.
    Livaudais JC, Hwang ES, Karliner L, Nápoles A, Stewart S, Bloom J, Kaplan CP (2012) Adjuvant hormonal therapy use among women with ductal carcinoma in situ. J Women’s Health (Larchmt) 21(1):35–42CrossRefGoogle Scholar
  39. 39.
    Yanez B, Stanton AL, Maly RC (2012) Breast cancer treatment decision making among Latinas and non-Latina whites: a communication model predicting decisional outcomes and quality of life. Health Psychol 31(5):552–561CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Hawley ST, Griggs JJ, Hamilton AS, Graff JJ, Janz NK, Morrow M, Jagsi R, Salem B, Katz SJ (2009) Decision involvement and receipt of mastectomy among racially and ethnically diverse breast cancer patients. J Natl Cancer Inst 101(19):1337–1347CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Hawley ST, Lantz PM, Janz NK, Salem B, Morrow M, Schwartz K, Liu L, Katz SJ (2007) Factors associated with patient involvement in surgical treatment decision making for breast cancer. Patient Educ Couns 65(3):387–395CrossRefPubMedGoogle Scholar
  42. 42.
    Andersen MR, Bowen DJ, Morea J, Stein KD, Baker F (2009) Involvement in decision-making and breast cancer survivor quality of life. Health Psychol 28(1):29–37CrossRefPubMedGoogle Scholar
  43. 43.
    Martinez LS, Schwartz JS, Freres D, Fraze T, Hornik RC (2009) Patient-clinician information engagement increases treatment decision satisfaction among cancer patients through feeling of being informed. Patient Educ Couns 77(3):384–390CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Arora NK, Weaver KE, Clayman ML, Oakley-Girvan I, Potosky AL (2009) Physicians’ decision-making style and psychosocial outcomes among cancer survivors. Patient Educ Couns 77(3):404–412CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Davies L, Rhodes LA, Grossman DC, Rosenberg MC, Stevens DP (2010) Decision making in head and neck cancer care. Laryngoscope 120(12):2434–2445CrossRefPubMedGoogle Scholar
  46. 46.
    Lee CJ, Gray SW, Lewis N (2010) Internet use leads cancer patients to be active health care consumers. Patient Educ Couns 81(Suppl):S63–S69CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Mazor KM, Beard RL, Alexander GL, Arora NK, Firneno C, Gaglio B, Greene SM, Lemay CA, Robinson BE, Roblin DW, Walsh K, Street RL Jr, Gallagher TH (2013) Patients’ and family members’ views on patient-centered communication during cancer care. Psychooncology 22(11):2487–2495CrossRefPubMedGoogle Scholar
  48. 48.
    Joseph-Williams N, Elwyn G, Edwards A (2014) Knowledge is not power for patients: a systematic review and thematic synthesis of patient-reported barriers and facilitators to shared decision making. Patient Educ Couns 94(3):129–309CrossRefGoogle Scholar
  49. 49.
    Puts MT, Tapscott B, Fitch M et al (2015) A systematic review of factors influencing older adults’ decision to accept or decline cancer treatment. Cancer Treat Rev 41(2):197–215CrossRefPubMedGoogle Scholar
  50. 50.
    Dean LT, Moss SL, McCarthy AM, Armstrong K (2017) Healthcare system distrust, physician trust, and patient discordance with adjuvant breast cancer treatment recommendations. Cancer Epidemiol Biomark Prev 26(12):1745–1752CrossRefGoogle Scholar
  51. 51.
    Cao W, Qi X, Yao T, Han X, Feng X (2017) How doctors communicate the initial diagnosis of cancer matters: cancer disclosure and its relationship with patients’ hope and trust. Psychooncology 26(5):640–648CrossRefPubMedGoogle Scholar
  52. 52.
    Kelm Z, Womer J, Walter JK, Feudtner C (2014) Interventions to cultivate physician empathy: a systematic review. BMC Med Educ 14:219CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Moore PM, Rivera S, Bravo-Soto GA, Olivares C, Lawrie TA (2018) Communication skills training for healthcare professionals working with people who have cancer. Cochrane Database Syst Rev 7:CD003751PubMedGoogle Scholar
  54. 54.
    The Commonwealth Fund (2018) Helping patients make better treatment choices with decision aids. Accessed 31 Jan 2019
  55. 55.
    Elwyn G, Frosch DL, Kobrin S (2016) Implementing shared decision-making: consider all the consequences. Implement Sci 11:114CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Tilburt JC, Wynia MK, Montori VM, Thorsteinsdottir B, Egginton JS, Sheeler RD, Liebow M, Humeniuk KM, Goold SD (2014) Shared decision-making as a cost-containment strategy: US physician reactions from a cross-sectional survey. BMJ Open 4(1):e004027CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    The Lewin Group (2008) Bending the curve: technical documentation prepared for the Commonwealth Fund. Accessed 31 Jan 2019
  58. 58.
    Chino F, Peppercorn JM, Rushing C, Kamal AH, Altomare I, Samsa G, Zafar SY (2017) Out-of-pocket costs, financial distress, and underinsurance in cancer care. JAMA Oncol 3(11):1582–1584CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Hughes TM, Merath K, Chen Q, Sun S, Palmer E, Idrees JJ, Okunrintemi V, Squires M, Beal EW, Pawlik TM (2018) Association of shared decision-making on patient-reported health outcomes and healthcare utilization. Am J Surg 216(1):7–12CrossRefPubMedGoogle Scholar
  60. 60.
    Kehl KL, Landrum MB, Arora NK, Ganz PA, van Ryn M, Mack JW, Keating NL (2015) Association of actual and preferred decision roles with patient-reported quality of care: shared decision making in cancer care. JAMA Oncol 1(1):50–58CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Pharmaceutical, Administrative and Social SciencesDuquesne University School of PharmacyPittsburghUSA
  2. 2.Division of Health Outcomes and Pharmacy PracticeThe University of Texas at Austin College of PharmacyAustinUSA
  3. 3.Division of Social and Administrative SciencesUniversity of Wisconsin–Madison School of PharmacyMadisonUSA
  4. 4.Health Economics and Outcomes ResearchNovartis OncologyEast HanoverUSA

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