How is shared decision making used in the treatment of patients with liver disease? a scoping review

Shared decision making (SDM) is an approach in which healthcare providers and patients collaboratively consider the best available evidence when making treatment decisions; patients are also supported in evaluating available options and forming informed preferences. However, evidence regarding treatment decision making contexts involving SDM for patients with liver disease remains limited. Therefore, this scoping review analyzes the contextual environments in which SDM is implemented during the treatment of patients with liver disease and examines the characteristics of patient participation in the SDM process.

This study focused on treatment decision making contexts (context) involving SDM (concept) among patients with liver disease (population). Following the Arksey and O'Malley scoping review method, structured searches of articles published until March 2025 were conducted in four electronic databases: PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, and Web of Science. The search terms used were "shared decision making" and "liver disease." Eight studies were ultimately included in the review.

SDM was applied in treatment contexts, including medication initiation, surgical decision making, and the selection of therapeutic approaches such as hepatic resection and radiofrequency ablation. Five (62.5%) out of the eight studies included surgery as an option, and four (50.0%) focused on patients with liver cancer. When the patients with liver disease participated in the SDM process, they were presented with treatment options, provided information about these options, and asked to express their preferences. However, only one study evaluated decision making outcomes.

Cancer-related and surgical decision making contexts were the most frequent targets for SDM in this review. However, patient decision aids (PDAs) are currently unavailable for any liver disease. Additionally, only one study included a process for re-evaluating prior decisions. Future research and clinical practice should incorporate mechanisms for re-evaluating prior decisions and support the development of PDAs for liver disease.