Shared decision-making and the duration of medical consultations: A systematic review and meta-analysis

• Published in: Patient education and counseling 2023-02, Vol.107, p.107561-107561, Article 107561
• Main Authors: Veenendaal, Haske van, Chernova, Genya, Bouman, Carlijn MB, Etten – Jamaludin, Faridi S.van, Dieren, Susan van, Ubbink, Dirk T.
• Format: Article
• Language: English
• Subjects: Consultation duration; Cross-Sectional Studies; Decision Making, Shared; Humans; Implementation; Multilevel; Patient Participation; Referral and Consultation; Shared decision-making; Systematic review
• ISSN: 0738-3991; 1873-5134
• DOI: 10.1016/j.pec.2022.11.003

1) determine whether increased levels of Shared Decision-Making (SDM) affect consultation duration, 2) investigate the intervention characteristics involved. MEDLINE, EMBASE, CINAHL and Cochrane library were systematically searched for experimental and cross-sectional studies up to December 2021. A best-evidence synthesis was performed, and interventions characteristics that increased at least one SDM-outcome, were pooled and descriptively analyzed. Sixty-three studies were selected: 28 randomized clinical trials, 8 quasi-experimental studies, and 27 cross-sectional studies. Overall, pooling of data was not possible due to substantial heterogeneity. No differences in consultation duration were found more often than increased or decreased durations. . Consultation times (minutes:seconds) were significantly increased only among interventions that: 1) targeted clinicians only (Mean Difference [MD] 1:30, 95% Confidence Interval [CI] 0:24–2:37); 2) were performed in primary care (MD 2:05, 95%CI 0:11–3:59; 3) used a group format (MD 2:25, 95%CI 0:45–4:05); 4) were not theory-based (MD 4:01, 95%CI 0:38–7:23). Applying SDM does not necessarily require longer consultation durations. Theory-based, multilevel implementation approaches possibly lower the risk of increasing consultation durations. The commonly heard concern that time hinders SDM implementation can be contradicted, but implementation demands multifaceted approaches and space for training and adapting work processes. •Introducing SDM does not necessarily lead to a prolonged consultation length.•Multilevel theory-based approaches seem important to avoid longer consultations.•Clinicians initially need time for training SDM skills and adapting work processes.•It is important to train and facilitate clinicians to work with decision tools.•Even if SDM increases consultation time, this is so limited that it justifies the effect.