Shared decision-making when considering hyperbaric oxygen therapy: a systematic review

Hyperbaric oxygen therapy (HBOT) is a treatment modality used for various non-acute medical conditions, ranging from ischaemic diabetic ulcers to late post-radiation damage. Despite its wide application, HBOT is often time-consuming, requires multiple sessions, and can be physically and psychologically challenging for patients, contributing to high drop-out rates. In addition, treatment results can vary significantly. These challenges suggest the need for more patient-centred approaches, such as shared decision-making (SDM), to improve patient engagement, satisfaction, and adherence to treatment. SDM, which involves patients in the decision-making process, could potentially improve outcomes and reduce dropout rates. This systematic review presents currently available evidence on the extent of SDM in patients eligible for HBOT.

A comprehensive literature search was conducted in the Medline, Embase, TRIP and Cochrane Central databases, from inception up to 29 August 2024, to find all studies with original data on SDM when considering HBOT as a treatment option. Study selection was conducted by two reviewers independently. Desired study outcomes were the application and observed levels of SDM.

The search yielded 988 articles of which 24 appeared eligible. After assessing the inclusion criteria and outcomes in the full text articles, zero remained for inclusion: none reported on patient involvement in the decision-making process regarding HBOT. However, six articles did mention that SDM should be an important element when developing clinical practice guidelines for HBOT.

Despite the obvious need for preference-sensitive decision-making in HBOT, there is no scientific evidence available on this topic. Possibly, physicians and patients consider HBOT as a last-resort or even the only treatment option. Consequently, involving the patient's preference regarding HBOT in the decision-making process is rarely documented. Hence, more awareness of the need for SDM is advocated when considering HBOT, which should be corroborated by research in this area.