Shared Decision-Making Tools Implemented in the Electronic Health Record: Scoping Review

Area of Science:

• Health Informatics
• Clinical Decision Support
• Patient Engagement

Background:

• Patient-centered care emphasizes patient involvement in healthcare decisions.
• Shared decision-making (SDM) implementation faces barriers like technical issues, time constraints, and workflow integration challenges.
• Electronic health records (EHRs) offer a platform for integrating SDM tools into clinical practice.

Purpose of the Study:

• To understand the integration and implementation characteristics of SDM interventions within EHR systems.
• To identify factors influencing the successful adoption of SDM tools in real-world clinical settings.

Main Methods:

• A scoping review was conducted using the Arksey and O'Malley framework with Joanna Briggs Institute guidance.
• Searched multiple databases (MEDLINE, Embase, CINAHL, Cochrane, PsycINFO, Scopus, Web of Science) for studies on SDM and EHR integration.
• Included original research and reviews focusing on real-world clinical settings and EHR integration; excluded retrospective studies, opinion pieces, and editorials.

Main Results:

• 18 studies (0.84%) met eligibility criteria, showing significant variation in SDM definitions, integration, and implementation.
• Integrating SDM tools into EHRs improved outcomes in 94% of studies.
• Most interventions targeted clinicians, with patient goals and values included in 56% of studies.

Conclusions:

• Integrating SDM tools into EHR clinician workflows is a logical step for routine practice.
• Standardization of SDM tools and processes, including patient decision aids, is crucial for consistency.
• Future research should focus on randomized controlled trials for EHR integration and implementation strategies, emphasizing patient values.