Many interacting patient, physician, health system and device/device market factors were said to influence PE. Factors were largely common for disparate types of devices and among physicians with different characteristics. These are summarized in Table 2 along with corresponding recommendations derived from Prokopetz et al. for engaging patients in PE . The summary presented in Table 2 provides physicians with a framework of topics by which to engage patients in discussions related to implantable medical devices. Table 2Factors constraining and enabling PE in decision-making about medical devicesCategoryConstraining factorsEnabling factorsaPatientBest fit for physical and demographic characteristicsPrognosis (life or death scenario)Age (device longevity greater than expected patient lifespan)Individual desire for PE (most prefer to let physicians decide)Capacity to understand complex, technical informationWell informed about manufacturers/devicesExplain why a particular implant is recommendedSolicit patient values and preferences regarding unknown risksProbe for other patient concerns and expectationsConfirm patient understandingPhysicianFamiliarity/comfort with specific device due to training/experienceTime required to educate patientsDisclose relevant financial relationshipsHealth systemFulfilment of purchasing group contractsUse of least costly device for same indicationRefer patient to another physician who uses a device preferred by the patientDevice or device marketComparative advantage of different devices for same indicationNumber of different devices available for the same indicationDiscuss available evidence in support of the deviceUse lay language to distinguish design features and trade-offs between different devicesaConstraining factors were mapped to relevant strategies (enabling factors) for shared decision-making in relation to medical devices that were recommended by Prokopetz et al. .