Shared decision making for persons with aphasia: a scoping review

ABSTRACT

Background

Shared decision making (SDM) is an evidence-based collaborative approach that promotes the involvement of patients in decision making. Persons with aphasia face additional challenges to participation in health decision making due to communication impairments. The purpose of this scoping review is to examine and synthesize available evidence on SDM approaches and interventions for persons with aphasia.

Methods

Our scoping review followed six stages: (1) identifying the research questions, (2) identifying relevant studies, (3) selecting the literature, (4) charting the data, (5) collating, summarizing and reporting results, and (6) consulting with a patient partner. We included peer reviewed and grey literature that report on SDM approaches for persons with aphasia making a healthcare treatment or screening decision. We provided a narrative synthesis of the findings.

Results

Of the 9588 identified citations, two studies were included. The first article was a commentary that presented a conceptual framework for achieving informed health decisions by exchanging medical information, eliciting values and preferences, and deliberating about the health decision. The second study examined speech-language pathologists’ (SLPs’) intentions to engage patients in SDM and their actual SDM behavior in clinical practice. Despite good intentions, SLPs dominated the discussion and faced barriers to using SDM with clients with aphasia.

Conclusions

There is a dearth of evidence informing the use of SDM for persons with aphasia. This population is at risk of being inappropriately excluded from decisions about their health due to their communication impairment. There is an ethical imperative to design, develop, and empirically evaluate SDM interventions tailored to persons with aphasia to ensure this population can make high quality and informed decisions that are consistent with their values and preferences.

KEYWORDS:

• Shared decision making
• Aphasia
• Scoping review
• Patient engagement

Acknowledgments

Financial support for this study was provided in part to Laura Boland (senior author) by a Canadian Institutes of Health Research Postdoctoral Fellowship (201811MFE-415427-152166) and the Integrated Knowledge Translation Research Network. Thank you also to The Tavistock Trust for Aphasia for awarding student prizes to Konstantina Charamis and Caitlin Parsons for their exceptional work on this project. We would like to thank all those who took the time to respond to our calls for information about potential research being conducted in shared decision making for persons with aphasia.

Availability of data and materials

All data used in this study are available in the included primary studies.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

All authors declare they have no financial relationships related to this article to disclose;Canadian Institutes of Health Research. IHSPR is a division that lives in CIHR [201811MFE-415427-152166].