Behaviour, barriers and facilitators of shared decision making in breast cancer surgical treatment: A qualitative systematic review using a ‘Best Fit’ framework approach

Abstract Background Due to the diversity and high sensitivity of the treatment, there were difficulties and uncertainties in the breast cancer surgical decision‐making process. We aimed to describe the patient's decision‐making behaviour and shared decision‐making (SDM)‐related barriers and facilitators in breast cancer surgical treatment. Methods We searched eight databases for qualitative studies and mixed‐method studies about breast cancer patients' surgical decision‐making process from inception to March 2021. The quality of the studies was critically appraised by two researchers independently. We used a ‘best fit framework approach’ to analyze and synthesize the evidence. Results Twenty‐eight qualitative studies and three mixed‐method studies were included in this study. Four themes and 10 subthemes were extracted: (a) struggling with various considerations, (b) actual decision‐making behaviours, (c) SDM not routinely implemented and (d) multiple facilitators and barriers to SDM. Conclusions Patients had various considerations of breast surgery and SDM was not routinely implemented. There was a discrepancy between information exchange behaviours, value clarification, decision support utilization and SDM due to cognitive and behavioural biases. When individuals made surgical decisions, their behaviours were affected by individual‐level and system‐level factors. Therefore, healthcare providers and other stakeholders should constantly improve communication skills and collaboration, and emphasize the importance of decision support, so as to embed SDM into routine practice. Patient and Public Contribution This systematic review was conducted as part of a wider research entitled: Breast cancer patients' actual participation roles in surgical decision making: a mixed method research. The results of this project helped us to better analyze and generalize patients' views.