{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T15:52:45Z","timestamp":1784562765338,"version":"3.55.0"},"reference-count":48,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2024,8,23]],"date-time":"2024-08-23T00:00:00Z","timestamp":1724371200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>The objective was to systematically review all studies focusing on barriers, facilitators, and tools currently available for shared decision making (SDM) in emergency departments (EDs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Background<\/jats:title><jats:p>Implementing SDM in EDs seems particularly challenging, considering the fast\u2010paced environment and sometimes life\u2010threatening situations. Over 10\u2009years ago, a previous review revealed only a few patient decision aids (PtDAs) available for EDs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Literature searches were conducted in MEDLINE, Embase, and Cochrane library, up to November 2023. Observational and interventional studies were included to address barriers or facilitators for SDM or to investigate effects of PtDAs on the level of SDM for patients visiting an ED.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We screened 1946 studies for eligibility, of which 33 were included. PtDAs studied in EDs address chest pain, syncope, analgesics usage, lumbar puncture, ureterolithiasis, vascular access, concussion\/brain bleeding, head\u2010CT choice, coaching for elderly people, and activation of patients with appendicitis. Only the primary outcome was meta\u2010analyzed, showing that PtDAs significantly increased the level of SDM (18.8 on the 100\u2010point OPTION scale; 95% CI 12.5\u201325.0). PtDAs also tended to increase patient knowledge, decrease decisional conflict and decrease health care services usage, with no obvious effect on overall patient satisfaction. Barriers and facilitators were identified on three levels: (1) patient level\u2014emotions, health literacy, and their own proactivity; (2) clinician level\u2014fear of medicolegal consequences, lack of SDM skills or knowledge, and their ideas about treatment superiority; and (3) system level\u2014time constraints, institutional guidelines, and availability of PtDAs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Circumstances in EDs are generally less favorable for SDM. However, PtDAs for conditions seen in EDs are helpful in overcoming barriers to SDM and are welcomed by patients. Even in EDs, SDM is feasible and supported by an increasing number of tools for patients and physicians.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.14998","type":"journal-article","created":{"date-parts":[[2024,8,24]],"date-time":"2024-08-24T05:54:53Z","timestamp":1724478893000},"page":"1037-1049","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Systematic review of barriers, facilitators, and tools to promote shared decision making in the emergency department"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9398-8879","authenticated-orcid":false,"given":"Dirk T.","family":"Ubbink","sequence":"first","affiliation":[{"name":"Department of Surgery Amsterdam University Medical Center at the University of Amsterdam, Location AMC  Amsterdam the 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