Shared Decision Making Tools Implemented in the Electronic Health Record: A Scoping Review (Preprint)

BACKGROUND Shared decision making (SDM) is a model of patient-centered care that encourages patients and clinicians to work together to reach medical decisions by weighing the risks and benefits of various options within the context of the values and goals of the patient. Despite the interest in incorporating SDM into routine care, current research studies identify various obstacles that limit SDM adoption. These obstacles include technical integration issues, logistical and workflow challenges, and psychological impediments such as uncertainty and legacy belief systems, which continue to impede progress. Integrating SDM tools and processes into EHR systems is often a complex and challenging problem. OBJECTIVE We aimed to understand the integration and implementation characteristics of reported Shared Decision Making (SDM) interventions integrated into an electronic health record (EHR) system. METHODS We conducted a scoping review using Arksey and O’Malleys' methodologic framework with guidance from the Joanna Briggs Institute. RESULTS A total of 19 studies of 2153 were included in the final review. There is a high degree of variation across studies, including SDM definitions, standardized measures, technical integration, and implementation strategies. SDM tools that target established healthcare processes promoted use. Integrating SDM templates and tools into an EHR appeared to improve the outcomes for most studies. Most SDM interventions were designed for clinicians. Patient-specific goals and values were not included in several studies. The two most common study outcome measures were patient satisfaction and SDM tool use. CONCLUSIONS Understanding the approaches for presenting SDM tools directly into a clinician’s workflow within the EHR is a logical approach to promoting SDM into routine clinical practice. This review contributes to the literature by illuminating features of SDM tools that have been integrated into an EHR system. Standardization of SDM tools and processes is needed for consistency across SDM studies. Targeting accepted clinical processes may enhance the adoption and use of SDM tools. Future studies designed as randomized control trials are needed to expand the quality of the evidence base. Keeping the goals and values of the patient at the center of shared decision making interactions is a key area for future studies.