{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T08:24:27Z","timestamp":1787300667803,"version":"build-2736575974"},"reference-count":60,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Med Decis Making"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Postmastectomy breast reconstruction (PMBR) is a preference-sensitive decision that requires alignment between clinical evidence and patient values. Shared decision making (SDM) supports patient-centered care, yet its systematic implementation in PMBR remains inconsistent. This mixed-methods systematic review synthesizes barriers and facilitators to SDM adoption and identifies strategies to improve decision quality, patient experience, and equity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      A systematic review was preregistered (OSF:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/osf.io\/mu9hv\">https:\/\/osf.io\/mu9hv<\/jats:ext-link>\n                      ) and conducted in accordance with PRISMA 2020 guidelines. Six databases (PubMed, Embase, Scopus, Web of Science, Cochrane Library, Trip Database) were searched from inception to November 2025. Eligible studies included qualitative, quantitative, or mixed-methods research examining barriers and\/or facilitators to SDM implementation in PMBR across micro (individual), meso (organizational), and macro (system) levels. Data were synthesized using a convergent integrated approach and mapped to the Consolidated Framework for Implementation Research.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Thirty-one studies (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 15\u2013485 participants) from North America, Europe, and Asia were included. SDM interventions\u2014particularly decision aids, digital tools, preconsultation education, and culturally tailored strategies\u2014improved patient knowledge (+6%\u201332%), decisional clarity, and satisfaction. Decisional conflict decreased by 13 to 25 points, and consultation time was reduced by up to 41%. Facilitators were identified across micro (eg, clinician engagement), meso (eg, multidisciplinary collaboration and organizational support), and macro (eg, supportive implementation strategies), whereas barriers included limited SDM literacy, workflow limitations and insufficient documentation, and structural inequities, respectively. Despite demonstrated effectiveness, sustained implementation was limited.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>SDM enhances informed and value-concordant decisions in PMBR. Effective implementation requires multilevel strategies, including clinician training, workflow integration, culturally adapted interventions, and organizational support. Future research should prioritize scalable and equitable models to ensure consistent integration of SDM into routine practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0272989x261473627","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T09:45:06Z","timestamp":1786959906000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Bridging the Gap between Intent and Implementation: A Mixed-Methods Systematic Review of Barriers and Enablers of Shared Decision Making in Postmastectomy Breast Reconstruction"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4852-5100","authenticated-orcid":false,"given":"Marta","family":"Maes-Carballo","sequence":"first","affiliation":[{"name":"Department of General Surgery, Hospital P\u00fablico de Ver\u00edn, Ourense, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Sampol-Ram\u00edrez","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Breast cancer Unit, Hospital Lucus Augusti, Lugo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"de-la-Puente-Mota","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Breast cancer Unit, Hospital Lucus Augusti, Lugo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Mart\u00ednez-Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Breast cancer Unit, Complexo Hospitalario de Ourense, Ourense, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yolanda","family":"G\u00f3mez-Fandi\u00f1o","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Breast cancer Unit, Hospital Lucus Augusti, Lugo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.16328"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.breast.2013.09.010"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-012-2349-1"},{"issue":"5","key":"e_1_3_2_5_2","article-title":"Shared decision-making in breast cancer reconstructive surgery: experience in a leading hospital","volume":"12","author":"Herrera de la Muela M","year":"2024","unstructured":"Herrera de la Muela M, et al. 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