Determinants of shared decision-making between people with dementia and informal caregivers: A systematic review

Objectives: Shared decision-making (SDM) between people with dementia and their caregivers is essential for home care arrangements. However, systematic understanding of influencing factors remains limited. This study aimed to identify modifiable determinants of shared decision-making and explore underlying theoretical mechanisms. Methods: A comprehensive search across seven databases yielded fourteen studies, extracted using Covidence, including study design, decision topics, determinants, primary outcome, and theoretical frameworks. Quality assessment was based on the Critical Appraisal Skills Programme Qualitative Checklists and Cohort Study Checklists. Results: Results showed that twelve studies used qualitative or mixed methods, with determinants primarily focusing on individual factors (e.g., PwD symptoms, caregiver burden), while interpersonal, community, and societal levels were overlooked. Care arrangement decisions were underexplored, and research lacked robust theoretical foundations. Conclusions: Current research focuses predominantly on individual-level factors while paying less attention to modifiable determinants from broader levels. The insufficient attention to care arrangement decisions and theoretical frameworks calls for a more comprehensive approach. Practice implications: Using Social Ecological Model, SDM interventions should simultaneously address individual needs, prioritize modifiable interpersonal factors, and incorporate broader environmental determinants to create comprehensive support systems on dementia caregiving.