Navigating Power Imbalances and Stigma in Mental Healthcare. Patient-Reported Barriers and Facilitators to Participation in Shared Decision-Making in Mental Health Care, a Qualitative Meta-Summary
Corresponding Author
Lien Mertens
Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
Correspondence: Lien Mertens ([email protected])
Contribution: Conceptualization, Writing - original draft, Formal analysis, Methodology
Search for more papers by this authorJoris Vandenberghe
Psychiatry Research Group, Department of Neurosciences KU Leuven, UPC KU Leuven, Leuven, Belgium
Contribution: Writing - review & editing
Search for more papers by this authorGeertruida Bekkering
Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
Belgian Centre for Evidence-Based Medicine, Leuven, Belgium
Contribution: Writing - review & editing
Search for more papers by this authorKarin Hannes
Research Group SoMeTHin'K, Faculty of Social Science, KU Leuven, Leuven, Belgium
Belgium; JBI Belgium: A JBI Affiliated Group, Leuven, Belgium
Contribution: Writing - review & editing, Supervision
Search for more papers by this authorNicolas Delvaux
Belgian Centre for Evidence-Based Medicine, Leuven, Belgium
Department of Public Health and Primary Care, Campus Kortrijk (KULAK) - KU Leuven, Belgium
Contribution: Writing - review & editing
Search for more papers by this authorPieter Van Bostraeten
Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
Contribution: Writing - review & editing
Search for more papers by this authorJasmien Jaeken
Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
Contribution: Writing - review & editing
Search for more papers by this authorBert Aertgeerts
Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
Belgian Centre for Evidence-Based Medicine, Leuven, Belgium
Contribution: Supervision, Writing - review & editing, Conceptualization
Search for more papers by this authorMieke Vermandere
Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
Contribution: Supervision, Writing - review & editing
Search for more papers by this authorCorresponding Author
Lien Mertens
Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
Correspondence: Lien Mertens ([email protected])
Contribution: Conceptualization, Writing - original draft, Formal analysis, Methodology
Search for more papers by this authorJoris Vandenberghe
Psychiatry Research Group, Department of Neurosciences KU Leuven, UPC KU Leuven, Leuven, Belgium
Contribution: Writing - review & editing
Search for more papers by this authorGeertruida Bekkering
Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
Belgian Centre for Evidence-Based Medicine, Leuven, Belgium
Contribution: Writing - review & editing
Search for more papers by this authorKarin Hannes
Research Group SoMeTHin'K, Faculty of Social Science, KU Leuven, Leuven, Belgium
Belgium; JBI Belgium: A JBI Affiliated Group, Leuven, Belgium
Contribution: Writing - review & editing, Supervision
Search for more papers by this authorNicolas Delvaux
Belgian Centre for Evidence-Based Medicine, Leuven, Belgium
Department of Public Health and Primary Care, Campus Kortrijk (KULAK) - KU Leuven, Belgium
Contribution: Writing - review & editing
Search for more papers by this authorPieter Van Bostraeten
Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
Contribution: Writing - review & editing
Search for more papers by this authorJasmien Jaeken
Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
Contribution: Writing - review & editing
Search for more papers by this authorBert Aertgeerts
Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
Belgian Centre for Evidence-Based Medicine, Leuven, Belgium
Contribution: Supervision, Writing - review & editing, Conceptualization
Search for more papers by this authorMieke Vermandere
Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
Contribution: Supervision, Writing - review & editing
Search for more papers by this authorABSTRACT
Background
The use of shared decision-making (SDM) in mental healthcare has been viewed as at least as important as its use in non-mental healthcare settings, but it still does not routinely take place in this setting. To further explore SDM processes with people with lived experience, we provide a qualitative meta-summary on patient-reported barriers and facilitators to participation in SDM within the context of mental healthcare.
Methods
Within the set of selected studies for a larger qualitative meta-summary, using five databases, we selected the studies that had surveyed patients with mental illness for further analysis in this paper. Search terms were based on the concepts: ‘decision making’, ‘patient participation’, ‘patient perceptions’ and ‘study design’ of patient reporting, including patient surveys, interviews and focus groups.
Results
Out of the 90 studies that had been selected for the larger review, we selected 13 articles concerning mental illness for more detailed analysis in this review. In total, we identified 29 different influencing factors and we found 6 major barriers: ‘Lack of choice’, ‘Not being respected as a person’, ‘Feeling stigma from physician’, ‘Disease burden’, ‘Power imbalance’ and ‘Low self-efficacy to participate’. ‘Clear information provision about options’, ‘Being respected as a person, being taken into account’, ‘Good physician-patient relationship’ and ‘Belief in the importance of one's own role’ were the main facilitators.
Conclusions
Stigma and self-stigma still seem to persist in mental healthcare and continue to suppress patients' self-efficacy to participate in SDM in this setting. There is much discussion of inclusion and diversity worldwide, and these themes are just as topical for patients with mental health problems. Further work seems necessary to eradicate all stigma and self-stigma in this setting when striving for care that could be ‘as shared as possible’.
Patient and Public Contribution
The authors wish to thank Mr. Walter Geuens, a person with lived experience in mental healthcare, for his careful reading and thorough feedback on the final paper.
Conflicts of Interest
The authors declare no conflicts of interest.
Open Research
Data Availability Statement
The authors have nothing to report.
Supporting Information
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References
- 1A. M. Stiggelbout, T. V. Weijden, M. P. T. D. Wit, et al., “Shared Decision Making: Really Putting Patients at the Centre of Healthcare,” BMJ 344 (2012): e256.
- 2G. Makoul and M. L. Clayman, “An Integrative Model of Shared Decision Making in Medical Encounters,” Patient Education and Counseling 60 (2006): 301–312.
- 3K. Niburski, E. Guadagno, S. Mohtashami, and D. Poenaru, “Shared Decision Making in Surgery: A Scoping Review of the Literature,” Health Expectations 23 (2020): 1241–1249.
- 4G. Elwyn, J. Tilburt, and V. Montori, “The Ethical Imperative for Shared Decision-Making,” European Journal for Person Centered Healthcare 1 (2013): 129–131.
10.5750/ejpch.v1i1.645 Google Scholar
- 5L. A. Shinkunas, C. J. Klipowicz, and E. M. Carlisle, “Shared Decision Making in Surgery: A Scoping Review of Patient and Surgeon Preferences,” BMC Medical Informatics and Decision Making 20 (2020): 190.
- 6M. J. Barry and S. Edgman-Levitan, “Shared Decision Making—The Pinnacle of Patient-Centered Care,” New England Journal of Medicine 366 (2012): 780–781.
- 7 Excellence NI for H and C. Standards Framework for Shared Decision-making Support Tools, Including Patient Decision Aids. 2023, https://www.nice.org.uk/corporate/ecd8.
- 8 Health TBD of Equity and Excellence: Liberating the NHS, 2010, https://www.gov.uk/government/publications/liberating-the-nhs-white-paper.
- 9(2019-2020) N helse og sykehusplan 2020 2023 K av MS 7. “The Norwegian Health and Hospital Plan”, https://www.regjeringen.no/no/dokumenter/nasjonal-helse-og-sykehusplan-2020-2023/id2679013/.
- 10P. Hahlweg, C. Bieber, A. Levke Brütt, et al., “Moving Towards Patient-Centered Care and Shared Decision-Making in Germany,” Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen 171 (2022): 49–57.
- 11Volksgezondheid F Overheidsdienst (FOD), Veiligheid van de Voedselketen en Leefmilieu CP. Wet Betreffende de Rechten van de Patiënt. 2024, https://www.health.belgium.be/sites/default/files/uploads/fields/fpshealth_theme_file/wet_van_22_augustus_2002_betreffende_de_rechten_van_de_patient_onofficiele_coordinatie.pdf.
- 12N. Couët, S. Desroches, H. Robitaille, et al., “Assessments of the Extent to Which Health-Care Providers Involve Patients in Decision Making: A Systematic Review of Studies Using the OPTION Instrument,” Health Expectations 18 (2015): 542–561.
- 13R. McCabe, H. Khanom, P. Bailey, and S. Priebe, “Shared Decision-Making in Ongoing Outpatient Psychiatric Treatment,” Patient Education and Counseling 91 (2013): 326–328.
- 14C. Seale, R. Chaplin, P. Lelliott, and A. Quirk, “Sharing Decisions in Consultations Involving Anti-Psychotic Medication: A Qualitative Study of Psychiatrists' Experiences,” Social Science & Medicine 62 (2006): 2861–2873.
- 15J. Hamann, B. Neuner, J. Kasper, et al., “Participation Preferences of Patients With Acute and Chronic Conditions,” Health Expectations 10 (2007): 358–363.
- 16N. J. Maples, D. I. Velligan, E. C. Jones, E. M. Espinosa, R. O. Morgan, and M. A. Valerio-Shewmaker, “Perspectives of Patients and Providers in Using Shared Decision Making in Psychiatry,” Community Mental Health Journal 58, no. 3 (2022): 578–588.
- 17D. Verwijmeren and K. P. Grootens, “Shifting Perspectives on the Challenges of Shared Decision Making in Mental Health Care,” Community Mental Health Journal 60 (2024): 292–307.
- 18L. Mertens, T. Kasmi, G. Bekkering, et al., “Shared Challenges and Opportunities: Uncovering Common Ground in Patient Participation Across Different Healthcare Settings and Patient Groups A Qualitative Meta-Summary on Patient-Reported Barriers and Facilitators to Participation in Shared Decision-Mak,” Patient Education and Counseling 130 (2025): 108475, https://doi.org/10.1016/j.pec.2024.108475.
- 19N. Joseph-Williams, G. Elwyn, and A. Edwards, “Knowledge Is Not Power for Patients: A Systematic Review and Thematic Synthesis of Patient-Reported Barriers and Facilitators to Shared Decision Making,” Patient Education and Counseling 94 (2014): 291–309.
- 20L. Boland, I. D. Graham, F. Légaré, et al., “Barriers and Facilitators of Pediatric Shared Decision-Making: A Systematic Review,” Implementation Science 14 (2019): 7.
- 21R. E. Pel-Littel, M. Snaterse, N. M. Teppich, et al., “Barriers and Facilitators for Shared Decision Making in Older Patients With Multiple Chronic Conditions: A Systematic Review,” BMC Geriatrics 21 (2021): 112.
- 22A. Waddell, A. Lennox, G. Spassova, and P. Bragge, “Barriers and Facilitators to Shared Decisionmaking in Hospitals From Policy to Practice: A Systematic Review,” Implementation Science 16 (2021): 74.
- 23N. G. Yılmaz, B. C. Schouten, S. Schinkel, and J. C. M. van Weert, “Information and Participation Preferences and Needs of Non-Western Ethnic Minority Cancer Patients and Survivors: A Systematic Review of the Literature,” Patient Education and Counseling 102 (2019): 631–650.
- 24M. Perez Jolles, J. Richmond, and K. C. Thomas, “Minority Patient Preferences, Barriers, and Facilitators for Shared Decision-Making With Health Care Providers in the USA: A Systematic Review,” Patient Education and Counseling 102 (2019): 1251–1262.
- 25R. L. Daly, F. Bunn, and C. Goodman, “Shared Decision-Making for People Living With Dementia in Extended Care Settings: A Systematic Review,” BMJ Open 8, no. 6 (2018): e018977.
- 26A.-J. Askey, Bee, B. Bloemsma, et al., “Facilitators and Barriers to Person-Centred Care in Child and Young People Mental Health Services: A Systematic Review,” Clinical Psychology & Psychotherapy 24, no. 4 (2016): 870–886.
- 27H. Cheng, D. Hayes, J. Edbrooke-Childs, K. Martin, L. Chapman, and M. Wolpert, “What Approaches for Promoting Shared Decision-Making Are Used in Child Mental Health? A Scoping Review,” Clinical Psychology & Psychotherapy 24 (2017): O1495–O1511.
- 28W. M. Bramer, D. Giustini, G. B. de Jonge, L. Holland, and T. Bekhuis, “De-Duplication of Database Search Results for Systematic Reviews in EndNote,” Journal of the Medical Library Association 104, no. 3 (2016): 240–243, https://doi.org/10.3163/1536-5050.104.3.014.
- 29M. J. Page, J. E. McKenzie, P. M. Bossuyt, et al., “The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews,” BMJ 372 (2021): n71.
- 30I. Scholl, A. LaRussa, P. Hahlweg, S. Kobrin, and G. Elwyn, “Organizational- and System-Level Characteristics That Influence Implementation of Shared Decision-Making and Strategies to Address Them—a Scoping Review,” Implementation Science 13 (2018): 40.
- 31S. M. Keij, H. C. Lie, R. Laidsaar-Powell, et al., “Patient-Related Characteristics Considered to Affect Patient Involvement in Shared Decision Making About Treatment: A Scoping Review of the Qualitative Literature,” Patient Education and Counseling 111 (2023): 107677.
- 32A. Villena-Jimena and J. M. Q. C. Morales-Asencio and HM, “‘It's That They Treated Me Like an Object’: A Qualitative Study on the Participation of People Diagnosed With Psychotic Disorders in Their Health Care,” International Journal of Environmental Research and Public Health 20, no. 5 (2023): 4614, https://doi.org/10.3390/ijerph20054614.
- 33Y. Aoki, T. Furuno, K. Watanabe, and M. Kayama, “Psychiatric Outpatients' Experiences With Shared Decision-Making: A Qualitative Descriptive Study,” Journal of Communication in Healthcare 12, no. 2 (2019): 102–111.
10.1080/17538068.2019.1612212 Google Scholar
- 34L. S. Beyene, E. Severinsson, B. S. Hansen, and K. Rørtveit, “Being in a Space of Sharing Decision-Making for Dignified Mental Care,” Journal of Psychiatric and Mental Health Nursing 26, no. 9–10 (2019): 368–376.
- 35E. R. Carrotte, M. E. Hartup, B. Lee-Bates, and M. Blanchard, “‘I Think That Everybody Should Be Involved’: What Informs Experiences of Shared Decision-Making in Supporting People Living With Schizophrenia Spectrum Disorders?,” Patient Education and Counseling 104, no. 7 (2021): 1583–1590.
- 36J. Eliacin, M. P. Salyers, M. Kukla, and M. S. Matthias, “Patients' Understanding of Shared Decision Making in a Mental Health Setting,” Qualitative Health Research 25, no. 5 (2015): 668–678.
- 37J. Eliacin, M. P. Salyers, M. Kukla, and M. S. Matthias, “Factors Influencing Patients' Preferences and Perceived Involvement in Shared Decision-Making in Mental Health Care,” Journal of Mental Health 24, no. 1 (2015): 24–28.
- 38P. Dahlqvist Jönsson, U.-K. Schön, D. Rosenberg, and M. S. P. Sandlund, “Service Users' Experiences of Participation in Decision Making in Mental Health Services,” Journal of Psychiatric and Mental Health Nursing 22, no. 9 (2015): 688–697.
- 39J. Delman, J. A. Clark, S. V. Eisen, and V. A. Parker, “Facilitators and Barriers to the Active Participation of Clients With Serious Mental Illnesses in Medication Decision Making: The Perceptions of Young Adult Clients,” Journal of Behavioral Health Services & Research 42, no. 2 (2015): 238–253.
- 40J. Hamann, S. Kohl, R. McCabe, et al., “What Can Patients Do to Facilitate Shared Decision Making? A Qualitative Study of Patients With Depression or Schizophrenia and Psychiatrists,” Social Psychiatry and Psychiatric Epidemiology 51, no. 4 (2016): 617–625.
- 41L. Kivelitz, M. C. Härter, J. Mohr, et al., “Choosing the Appropriate Treatment Setting: Which Information and Decision-Making Needs Do Adult Inpatients With Mental Disorders Have? A Qualitative Interview Study,” Patient Preference and Adherence 12 (2018): 823–833.
- 42R. Kokanović, L. Brophy, B. McSherry, J. Flore, K. Moeller-Saxone, and H. Herrman, “Supported Decision-Making From the Perspectives of Mental Health Service Users, Family Members Supporting Them and Mental Health Practitioners,” Australian & New Zealand Journal of Psychiatry 52, no. 9 (2018): 826–833.
- 43E. B. Matthews, M. Savoy, A. Paranjape, et al., “Shared Decision Making in Primary Care Based Depression Treatment: Communication and Decision-Making Preferences Among an Underserved Patient Population,” Frontiers in Psychiatry 12 (2021): 681165.
- 44S. Rodenburg-Vandenbussche, I. Carlier, I. van Vliet, A. van Hemert, and A. Z. F. Stiggelbout, “Patients' and Clinicians' Perspectives on Shared Decision-Making Regarding Treatment Decisions for Depression, Anxiety Disorders, and Obsessive-Compulsive Disorder in Specialized Psychiatric Care,” Journal of Evaluation in Clinical Practice 26, no. 2 (2020): 645–658.
- 45S. Y. An, G. H. Kim, and J. Y. Kim, “Effectiveness of Shared Decision-Making Training Program in People With Schizophrenia in South Korea,” Perspectives in Psychiatric Care 53, no. 2 (2017): 111–118.
- 46L. Beyene, E. Severinsson, and B. R. K. Hansen, “Shared Decision-Making-Balancing Between Power and Responsibility as Mental Healthcare Professionals in a Therapeutic Milieu,” SAGE Open Nursing 4 (2018): 2377960817752159, https://doi.org/10.1177/2377960817752159.
- 47P. E. Deegan, E. Carpenter-Song, R. E. Drake, J. A. Naslund, A. Luciano, and S. L. Hutchison, “Enhancing Clients' Communication Regarding Goals for Using Psychiatric Medications,” Psychiatric Services 68, no. 8 (2017): 771–775.
- 48R. E. Drake, P. E. Deegan, and C. Rapp, “The Promise of Shared Decision Making in Mental Health,” Psychiatric Rehabilitation Journal 34, no. 1 (2010): 7–13.
- 49K. Drivenes, V. Ø. Haaland, T. Mesel, and L. Tanum, “Practitioners' Positive Attitudes Promote Shared Decision-Making in Mental Health Care,” Journal of Evaluation in Clinical Practice 25, no. 6 (2019): 1041–1049.
- 50J. Hamann, R. Mendel, S. Reiter, et al., “Why Do Some Patients With Schizophrenia Want to Be Engaged in Medical Decision Making and Others Do Not?,” Journal of Clinical Psychiatry 72, no. 12 (2011): 1636–1643.
- 51C. Huang, V. Plummer, L. Lam, and W. Cross, “Perceptions of Shared Decision-Making in Severe Mental Illness: An Integrative Review,” Journal of Psychiatric and Mental Health Nursing 27, no. 2 (2020): 103–127.
- 52D. V. Jeste, G. M. L. Eglit, B. W. Palmer, J. G. Martinis, P. Blanck, and E. R. Saks, “Supported Decision Making in Serious Mental Illness,” Psychiatry 81, no. 1 (2018): 28–40.
- 53K. Jørgensen and J. D. Rendtorff, “Patient Participation in Mental Health Care—Perspectives of Healthcare Professionals: An Integrative Review,” Scandinavian Journal of Caring Sciences 32, no. 2 (2018): 490–501.
- 54D. Kalsi, J. Ward, R. Lee, K. Fulford, and A. Handa, “Shared Decision-Making Across the Specialties: Much Potential But Many Challenges,” Journal of Evaluation in Clinical Practice 25, no. 6 (2019): 1050–1054.
- 55R. McCabe, “Involvement in Decision Making: The Devil Is in the Detail,” World Psychiatry 16, no. 2 (2017): 155–156.
- 56A. Mucci, W. Kawohl, C. Maria, and A. Wooller, “Treating Schizophrenia: Open Conversations and Stronger Relationships Through Psychoeducation and Shared Decision-Making,” Frontiers in Psychiatry 11 (2020): 761.
- 57J. Hamann and S. Heres, “Adapting Shared Decision Making for Individuals With Severe Mental Illness,” Psychiatric Services 65, no. 1 (2014): 1483–1486.
- 58L. A. Mistler and R. E. Drake, “Shared Decision Making in Antipsychotic Management,” Journal of Psychiatric Practice 14 (2008): 333–344.
- 59M. Kopera, H. Suszek, E. Bonar, et al., “Evaluating Explicit and Implicit Stigma of Mental Illness in Mental Health Professionals and Medical Students,” Community Mental Health Journal 51, no. 5 (2015): 628–634.
- 60J. Hamann, M. Bühner, and N. Rüsch, “Self-Stigma and Consumer Participation in Shared Decision Making in Mental Health Services,” Psychiatric Services 68, no. 8 (2017): 783–788.
- 61C. Schauer, A. Everett, P. del Vecchio, and L. Anderson, “Promoting the Value and Practice of Shared Decision-Making in Mental Healthcare,” Psychiatric Rehabilitation Journal 31, no. 1 (2007): 54–61.
- 62J. Moran-Sanchez and P. B. L. M. Gomez-Valles, “Shared Decision-Making in Outpatients With Mental Disorders: Patients' Preferences and Associated Factors,” Journal of Evaluation in Clinical Practice 25, no. 6 (2019): 1200–1209.
- 63L. Gg, “Overcoming Obstacles to Shared Mental Health Decision Making,” AMA Journal of Ethics 22, no. 5 (2020): E446–E451.
- 64E. A. Rake, I. C. H. Box, D. Dreesens, et al., “Bringing Personal Perspective Elicitation to the Heart of Shared Decision-Making: A Scoping Review,” Patient Education and Counseling 105 (2022): 2860–2870.
- 65R. Oueslati, A. J. Woudstra, R. Alkirawan, et al., “What Value Structure Underlies Shared Decision Making? A Qualitative Synthesis of Models of Shared Decision Making,” Patient Education and Counseling 124 (2024): 108284.
- 66 World Health Organization. Quality Rights Materials for Training, Guidance and Transformation. 2019, https://www.who.int/publications/i/item/whoqualityrights-guidance-and-training-tools.
- 67W. T. Carpenter, Jr., “Decisional Capacity for Informed Consent in Schizophrenia Research,” Archives of General Psychiatry 57 (2000): 533–538.
- 68D. E. M. van der Horst, M. M. Garvelink, W. J. W. Bos, A. M. Stiggelbout, and A. H. Pieterse, “For Which Decisions Is Shared Decision Making Considered Appropriate?—A Systematic Review,” Patient Education and Counseling 106 (2023): 3–16.
- 69D. J. Opel, M. T. Gerstein, A. C. Carle, et al., “Saving Shared Decision-Making,” Journal of General Internal Medicine (2025), https://doi.org/10.1007/s11606-025-09410-z.
- 70Y. Zisman-Ilani, P. H. Lysaker, and I. Hasson-Ohayon, “Shared Risk Taking: Shared Decision Making in Serious Mental Illness,” Psychiatric Services 72, no. 4 (2021): 461–463.
- 71Y. O. Alanen, K. Lehtinen, V. Räkköläinen, and J. Aaltonen, “Need-Adapted Treatment of New Schizophrenic Patients: Experiences and Results of the Turku Project,” Acta Psychiatrica Scandinavica 83 (1991): 363–372.
- 72S. von Peter, V. Aderhold, L. Cubellis, et al., “Open Dialogue as a Human Rights-Aligned Approach,” Frontiers in Psychiatry 10 (2019): 387.
- 73A. M. Freeman, R. H. Tribe, J. C. H. Stott, and S. Pilling, “Open Dialogue: A Review of the Evidence,” Psychiatric Services 70 (2019): 46–59.
- 74S. R. C. U. Callaghan. An Evolving Revolution: Evaluating Australia's Compliance With the Convention on the Rights of Persons With Disabilities in Mental Health Law. 2016.
- 75J. Swanson, M. Swartz, M. Hannon, et al., “Psychiatric Advance Directives: A Survey of Persons With Schizophrenia, Family Members, and Treatment Providers,” International Journal of Forensic Mental Health 2 (2003): 73–86.
10.1080/14999013.2003.10471180 Google Scholar
- 76P. Gulbrandsen, M. L. Clayman, M. C. Beach, et al., “Shared Decision-Making as an Existential Journey: Aiming for Restored Autonomous Capacity,” Patient Education and Counseling 99 (2016): 1505–1510.
- 77P. Gulbrandsen, M. L. Clayman, M. C. Beach, et al., “Shared Decision-Making as an Existential Journey: Aiming for Restored Autonomous Capacity,” Patient Education and Counseling 99 (2016): 1505–1510.
- 78P. A. Ubel, K. A. Scherr, and A. Fagerlin, “Autonomy: What's Shared Decision Making Have to Do With It?,” American Journal of Bioethics 18 (2018): W11–W12.
- 79A. C. Zagt, N. Bos, M. Bakker, D. de Boer, R. D. Friele, and J. D. de Jong, “A Scoping Review Into the Explanations for Differences in the Degrees of Shared Decision Making Experienced by Patients,” Patient Education and Counseling 118 (2024): 108030.
- 80W. Chen, H. Zhang, M. Xu, and R. Huang, “Differences in Shared Decision-Making: The East-West Divide,” BMJ Evidence-Based Medicine 29 (2023): 289–291, https://doi.org/10.1136/bmjebm-2023-112451.
