Review Article| Volume 23, ISSUE 1, e20-e31, January 2023

Frequency and Influencing Factors of Shared Decision Making Among Breast Cancer Patients Receiving Surgery: A Systematic Review and Meta-Analysis

  • Hongying Zheng
    School of Nursing, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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  • Linning Yang
    Reproductive Medicine Center, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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  • Jiale Hu
    Address for correspondence: Jiale Hu, PhD, Department of Nurse Anesthesia, Virginia Commonwealth University, 900 E. Leigh Street, Richmond, VA, 23298.
    Department of Nurse Anesthesia, Virginia Commonwealth University, Richmond, VA, USA
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  • Yan Yang
    Address for correspondence: Yan Yang, PhD, School of Nursing, Shanghai Jiao Tong University, 227 South Chong Qing Road, Shanghai 200025, China.
    School of Nursing, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Published:October 17, 2022DOI:


      Due to the diversified and high sensitivity of breast cancer surgical treatment, various decision making styles show different functions in making trade-offs and sharing information. Shared decision making is the best practice paradigm to promote health outcomes. This study aimed to determine the overall frequency of shared decision making and explore influencing factors during the surgical decision-making process from breast cancer patients’ perspectives. We searched 8 databases for studies about breast cancer patients’ surgical decisional control preferences and shared decision making preference. Two researchers screened the literature, extracted the data, and evaluated the literature quality. Meta-analysis of the frequency of preferred and actual shared decision making and decision congruence was performed. Due to the limited studies of influencing factors, descriptive analysis was used. Fourteen original studies were included in this study. We found the overall pooled frequency of the preferred shared decision making of 48.1% (95%CI 33.5%, 62.6%) and the actual shared decision making of 38.1% (95%CI 33.9%, 42.2%). Moreover, the pooled frequency of the decision congruence between preferred and actual decision styles was 61.7% (95%CI 54.6%, 68.8%). The descriptive analysis findings indicated that the influencing factors of shared decision making included individual factors, surgeon-patient communication factors, and health setting factors. There was a gap between the preferred and actual decision styles in the surgical context. Therefore, health care providers should identify potential shared decision making barriers and facilitators, and advocate the clinical shared decision making model to embed shared decision making into routine practice.


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