Shared decision-making using personal health record technology: a scoping review at the crossroads

J Am Med Inform Assoc. 2017 Jul 1;24(4):857-866. doi: 10.1093/jamia/ocw172.

Abstract

Objective: This scoping review aims to determine the size and scope of the published literature on shared decision-making (SDM) using personal health record (PHR) technology and to map the literature in terms of system design and outcomes.

Materials and methods: Literature from Medline, Google Scholar, Cumulative Index to Nursing and Allied Health Literature, Engineering Village, and Web of Science (2005-2015) using the search terms "personal health records," "shared decision making," "patient-provider communication," "decision aid," and "decision support" was included. Articles ( n = 38) addressed the efficacy or effectiveness of PHRs for SDM in engaging patients in self-care and decision-making or ways patients can be supported in SDM via PHR.

Results: Analysis resulted in an integrated SDM-PHR conceptual framework. An increased interest in SDM via PHR is apparent, with 55% of articles published within last 3 years. Sixty percent of the literature originates from the United States. Twenty-six articles address a particular clinical condition, with 10 focused on diabetes, and one-third offer empirical evidence of patient outcomes. The tethered and standalone PHR architectural types were most studied, while the interconnected PHR type was the focus of more recently published methodological approaches and discussion articles.

Discussion: The study reveals a scarcity of rigorous research on SDM via PHR. Research has focused on one or a few of the SDM elements and not on the intended complete process.

Conclusion: Just as PHR technology designed on an interconnected architecture has the potential to facilitate SDM, integrating the SDM process into PHR technology has the potential to drive PHR value.

Keywords: decision support; patient-centered care; personal health records; self-management; shared decision-making.

Publication types

  • Review

MeSH terms

  • Decision Making*
  • Decision Support Techniques
  • Electronic Health Records
  • Health Records, Personal*
  • Humans
  • Patient Participation*
  • Physician-Patient Relations
  • Self-Management