Key targets for activating anaesthesia shared decision-making: a mixed methods systematic review

Shared decision-making in anaesthesia is widely endorsed yet delivered inconsistently. This mixed methods systematic review aimed to identify primary activation targets for enhancing shared decision-making in peri-operative anaesthesia practice.

Databases were searched for qualitative, quantitative and mixed methods studies employing shared decision-making in adult anaesthesia. Data were narratively synthesised, appraised with the Mixed Method Appraisal Tool, and mapped to the Theoretical Domains Framework to identify behavioural determinants. Findings were grouped at clinician, patient and system levels to derive shared decision-making activation targets.

Eleven studies met inclusion criteria. Synthesis yielded nine activation targets across levels. Clinician-focused priorities included: training in shared decision-making communication with rehearsal and feedback; structured elicitation of patient preferences using open questions and direct invitations; and avoiding assumptions about patient capacity during shared decision-making discussions. Patient-level priorities required making anaesthesia choices explicit; providing anxiety-reducing explanations; and ensuring accessible educational materials. Scheduling shared decision-making earlier in the care pathway, protecting consultation time and offering decision support before appointments emerged as system-level priorities, alongside embedding shared decision-making prompts within clinic templates to support workflow integration.

This review identifies that shared decision-making in anaesthesia requires co-ordinated action on key activation targets. To embed shared decision-making into routine clinical workflows, earlier consultation scheduling, protected time for anaesthesia discussions and the use of standardised shared decision-making tools with accessible patient information are priority components for service enhancement. The theoretically-informed findings offer a practical route moving anaesthesia practice away from tokenistic shared decision-making endorsement, towards streamlined, patient-centred shared decision-making delivery in anaesthetic care.