A scoping review into the explanations for differences in the degrees of shared decision making experienced by patients

In order to improve the degree of shared decision making (SDM) experienced by patients, it is necessary to gain insight into the explanations for the differences in these degrees. A scoping review of the literature on the explanations for differences in the degree of SDM experienced by patients was conducted. We assessed 21,329 references. Ultimately, 308 studies were included. The explanations were divided into micro, meso, and macro levels. The explanations are mainly related to the micro level. They include explanations related to the patient and healthcare professionals, the relationship between the patient and the physician, and the involvement of the patient’s relatives. On the macro level, explanations are related to restrictions within the healthcare system such as time constraints, and adequate information about treatment options. On the meso level, explanations are related to the continuity of care and the involvement of other healthcare professionals. SDM is not an isolated process between the physician and patient. Explanations are connected to the macro, meso, and micro levels. This scoping review suggests that there could be more focus on explanations related to the macro and meso levels, and on how explanations at different levels are interrelated. •Most research into explaining shared decision making (SDM) experienced by patients focuses on the micro level.•Explanations on the meso and macro levels have not been sufficiently researched.•Such explanations could have an unique contribution to the degree of SDM experienced by patients.•More knowledge is needed about explanations related to the macro and meso levels.•Besides, more knowledge is needed about how explanations on the three different levels are interrelated.