Marie?Anne Durand|Lewis Carpenter|Hayley Dolan|Paulina Bravo|Mala Mann|Frances Bunn|Glyn Elwyn
Do Interventions Designed to Support Shared Decision-Making Reduce Health Inequalities? A Systematic Review and Meta-Analysis
University of Hertfordshire|Centre for Life|University of Hertfordshire|Centre for Life|University of Hertfordshire|Centre for Life|Pontificia Universidad Católica de Chile|Cardiff University|University of Hertfordshire|Dartmouth College
increasing patient engagement healthcare become health policy priority however concern promoting supported shared decisionmaking could increase health inequalitiesto evaluate impact sdm interventions disadvantaged groups health inequalitiessystematic review metaanalysis randomised controlled trials observational studiescinahl cochrane register controlled trials cochrane database systematic reviews embase hmic medline nhs economic evaluation database open sigle psycinfo web knowledge searched inception june 2012we included studies without language restriction met following two criteria 1 assess effect shared decisionmaking interventions disadvantaged groups andor health inequalities 2 include least 50 people disadvantaged groups except separate analysis conducted groupwe included 19 studies pooled 10 metaanalysis metaanalyses showed moderate positive effect shared decisionmaking interventions disadvantaged patients narrative synthesis suggested overall sdm interventions increased knowledge informed choice participation decisionmaking decision selfefficacy preference collaborative decision making reduced decisional conflict among disadvantaged patients 7 19 studies compared interventions effect high low literacy groups overall sdm interventions seemed benefit disadvantaged groups eg lower literacy higher literacy education socioeconomic status interventions tailored disadvantaged groups needs appeared effectiveresults indicate shared decisionmaking interventions significantly improve outcomes disadvantaged patients according narrative synthesis sdm interventions may beneficial disadvantaged groups higher literacysocioeconomic status patients however given small sample sizes variety intervention types study design quality findings interpreted caution