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Review
February 3, 2021

Shared Decision-making in Dermatology: A Scoping Review

Author Affiliations
  • 1Oregon Health & Science University Center for Health & Healing, Portland
JAMA Dermatol. 2021;157(3):330-337. doi:10.1001/jamadermatol.2020.5362
Key Points

Question  What are the characteristics and range of methods used in shared decision-making in dermatology?

Findings  This scoping review of 29 studies revealed literature on shared decision-making in dermatology, describing the benefits and barriers as well as the tools available specific to dermatology. Patients and physicians share an interest in decision-making, but dermatologists have not widely adopted the practice of shared decision-making.

Meaning  The results of this review suggest that the development of more patient decision aids for specific diseases is warranted, but the reluctance of dermatologists to include shared decision-making should be explored.

Abstract

Importance  Shared decision-making (SDM) can improve the quality of care for patients. The extent to which this tool has been used and the evidence supporting its use in dermatology have not been systematically examined.

Objective  To perform a scoping review of the literature regarding SDM in dermatology.

Evidence Review  Searches of Ovid MEDLINE, PsycINFO, PsycARTICLES, Sciverse Scopus, and EBM Reviews were conduced on July 11, 2019, and March 6, 2020. There were no limits on date, type of article, language, or subject for the initial search. A total of 1673 titles and abstracts were screened by 2 independent reviewers in the Covidence mixed-methods platform. Forty-one full-text studies were assessed for eligibility. For inclusion, articles needed to include a dermatologic diagnosis as well as discussion of SDM or patient decision aids. Two independent reviewers screened 29 full-text articles for inclusion and extracted qualitative data using a set of 26 predefined codes. Qualitative coding was applied to excerpts to categorize the article, define and describe advantages and disadvantages of SDM, understand patient and physician requests for SDM, and discuss methods of implementation.

Findings  Despite a small number of articles on SDM (n = 29) in dermatology, the selected literature provided consistent messages regarding the importance of SDM for dermatology and a number of strategies and tools for implementation. Medical dermatology was the most common subspecialty studied, with melanoma, psoriasis, and connective tissue diseases most examined. Only 5 publications introduced SDM tools specifically for dermatologic conditions; of these, only 2 tools were validated. Barriers to implementation that were cited included time and a lack of training for clinicians, although the literature also provided potential solutions to these issues. All articles emphasized the value of SDM for both patients and physicians.

Conclusions and Relevance  The literature regarding SDM in dermatology consistently suggests that it is a useful tool for providing patient-centered care. Established tools have been proposed since 2012. More research is needed to implement better practices, especially in dermatologic subspecialties. However, there are substantial suggestions from the literature for strategies and tools with which to begin a shared decision-making practice.

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