What are the external influences on information exchange and shared decision-making in healthcare consultations: a meta-synthesis of the literature

Patient Educ Couns. 2009 Apr;75(1):37-52. doi: 10.1016/j.pec.2008.09.025. Epub 2008 Nov 25.


Objective: To review the literature to identify external influences on information exchange and shared decision-making in healthcare consultations and conceptualise how information is used both outside and within a consultation.

Methods: A 'meta-study' approach (meta-data-analysis, meta-theory, meta-method, and meta-synthesis) was used to locate, review, synthesise and summarise the findings, methodology, theoretical orientation and interpretation of qualitative research papers.

Results: In a model of external influences on information exchange within healthcare consultations, practitioner influences were: receptiveness to informed patients and patient choice, lack of knowledge of cultural difference, patient centredness vs. stereotyping. Patient influences were: motivation to seek and engage with information; the appraisal of information before a consultation, expression of cultural identity, and ways of managing the risk of poor information. Shared influences were: differing illness notions, role expectations and language. Empowerment, disempowerment and non-empowerment were outcomes of information exchange and health literacy was a mediator of external influences and empowerment.

Conclusion: This meta-study provides a conceptualisation of external influences on information exchange in shared decision-making where health literacy mediates patient related influences and is also an influence on empowerment.

Practice implications: Our model can inform the development of interventions aimed at improving information exchange and shared decision-making, potentially contributing to more equitable healthcare encounters.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adult
  • Aged
  • Anthropology, Cultural
  • Communication Barriers*
  • Cultural Diversity
  • Decision Making*
  • Educational Status
  • Female
  • Humans
  • Male
  • Middle Aged
  • Patient Participation*
  • Power, Psychological
  • Professional-Patient Relations*
  • Qualitative Research