Innovation in aging · 2026
Exploring barriers and facilitators to shared decision-making for older adults in East Asian health systems: a scoping review.
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Lee Seung Eun, Hwang Misun, Jiang Yun
Аннотация
BACKGROUND AND OBJECTIVES: Shared decision-making (SDM) is a core component of patient-centered care, yet evidence on SDM among older adults is largely derived from Western healthcare systems. Given sociocultural differences in East Asian contexts, particularly regarding family involvement, the transferability of Western SDM models remains uncertain. This study aimed to identify barriers and facilitators to SDM for older adults in East Asian healthcare systems across stakeholder groups.
METHODS: A scoping review was conducted following the Arksey and O'Malley framework and PRISMA-ScR guidelines. Six databases were searched from inception to October 2025 for studies focused on older adults (≥65 years) in East Asian settings. Findings were synthesized descriptively and organized across 4 stakeholder groups: patients, caregivers, clinicians, and health systems.
RESULTS: Twenty studies published between 2011 and 2025 were included. SDM was most examined in end-of-life care, life-sustaining treatment decisions, and advance care planning. Patient-related barriers included limited information and literacy, poorer health and financial burden, psychological distress, and constrained autonomy. Caregiver-related factors reflected family-dominated decision-making dynamics that could both hinder and support SDM. Barriers regarding clinicians included clinician-centered practices, limited interaction, and delayed discussions, while those in health systems included insufficient decision-support infrastructure and resource constraints.
DISCUSSION AND IMPLICATIONS: SDM for older adults in East Asia is shaped by interacting influences involving patients, caregivers, clinicians, and health systems, with family involvement playing a central contextual role. Culturally responsive SDM approaches and research beyond end-of-life contexts are needed to support meaningful participation in clinical decision-making across care settings.
METHODS: A scoping review was conducted following the Arksey and O'Malley framework and PRISMA-ScR guidelines. Six databases were searched from inception to October 2025 for studies focused on older adults (≥65 years) in East Asian settings. Findings were synthesized descriptively and organized across 4 stakeholder groups: patients, caregivers, clinicians, and health systems.
RESULTS: Twenty studies published between 2011 and 2025 were included. SDM was most examined in end-of-life care, life-sustaining treatment decisions, and advance care planning. Patient-related barriers included limited information and literacy, poorer health and financial burden, psychological distress, and constrained autonomy. Caregiver-related factors reflected family-dominated decision-making dynamics that could both hinder and support SDM. Barriers regarding clinicians included clinician-centered practices, limited interaction, and delayed discussions, while those in health systems included insufficient decision-support infrastructure and resource constraints.
DISCUSSION AND IMPLICATIONS: SDM for older adults in East Asia is shaped by interacting influences involving patients, caregivers, clinicians, and health systems, with family involvement playing a central contextual role. Culturally responsive SDM approaches and research beyond end-of-life contexts are needed to support meaningful participation in clinical decision-making across care settings.