Factors Influencing the Adoption of Shared Decision Making for Antibiotic Treatments in Developing Countries: A Systematic Review of Physicians and Patients' Perspectives

Background

Shared decision-making is a decision-making process that involves both patients and their healthcare providers and can serve as a framework to reduce inappropriate antibiotic prescribing, thereby helping to control antibiotic resistance. However, little is known about the factors that influence the adoption of shared decision-making for antibiotic prescription in developing countries.

Objectives

The objective of this review is to identify factors influencing the adoption of shared decision-making for antibiotic prescription from both physicians' and patients' perspectives in developing countries.

Methods

We searched four electronic databases, Web of Science, Scopus, PubMed and ProQuest Health and Medicine, from 3 July 2023 to August 20, 2023. Studies were included if they assessed factors influencing the practice of shared decision-making during antibiotics prescription from physicians' or patients' perspectives in developing countries. The included studies were published in English and used quantitative, qualitative or mixed-method designs, spanning 2010 and 2023. The quality of the included articles was assessed using the Mixed Method Appraisal Tool (MMAT) version 2018, and data extraction from selected articles was performed by the first author and co-authors. Narrative synthesis was used to synthesis the qualitative result and incorporate quantitative data.

Results

Initially, a total of 2120 studies were identified. After evaluating the inclusion criteria, 24 were included in the final analysis. The main factors that influence the adoption of shared decision-making (SDM) in developing countries are time constraints, misunderstanding of shared decision-making, cultural and socioeconomic influence, power dynamics differences (hierarchical relationship between physicians and patients), patients' preference and agreement with shared decision-making, and availability of resources. Additionally, the quality of the relationship between patients and physicians plays a key role in influencing the practice of shared decision-making.

Conclusion

The findings highlight the importance of interventions aimed at both physicians and patients, such as education and training programs focused on shared decision-making for antibiotic prescription. However, further study is required to develop effective strategies that promote the adoption of shared decision-making practices while considering the contextual factors at play.