Background and objectives

Shared decision-making (SDM) is globally recognized as a core component of patient-centered care. Commonly defined as a collaborative process in which patients and healthcare professionals work together to reach informed decisions about diagnosis, treatment, and ongoing management, SDM involves key steps such as presenting options, discussing potential benefits and harms, and eliciting and integrating patient values and preferences.1,2 Successful SDM has been consistently associated with positive patient outcomes, including greater satisfaction, improved trust in clinicians, and better symptom management.3,4 Reflecting this evidence, there has been a significant movement to integrate SDM into routine clinical practice and health policy. Countries such as the United Kingdom, through the National Institute for Health and Care Excellence (NICE) guidelines,5 and the United States, through the Agency for Healthcare Research and Quality (AHRQ)’s SHARE approach,6 have developed national guidelines, training curricula, and patient decision aids to institutionalize SDM within health system reforms that emphasize patient autonomy.

Despite the global recognition of SDM, its conceptualization and implementation in East Asian health contexts remain comparatively underexplored. Healthcare systems are embedded within distinct sociocultural and clinical contexts, which shape how SDM is understood and practiced; as a result, Western-derived models cannot be assumed to translate seamlessly to East Asian settings.7 In this region, contextual differences often manifest as structural and cultural constraints within the clinical environment, including high patient volumes, brief consultation times, and hierarchical norms shaping patient–clinician communication, often characterized by clinician authority, patient deference, and more directive communication styles.8,9 These factors collectively limit the time, flexibility, and relational space required to engage in comprehensive SDM processes.10 Although interest in patient-centered care and SDM is growing in East Asia, empirical evidence on the specific barriers and facilitators of SDM in this region remains limited.10

To move beyond generic application and develop context-sensitive implementation strategies, there is a critical need to identify and map the barriers and facilitators that influence SDM for the older adult population in East Asian settings. Older adults represent a particularly important population in East Asian healthcare systems, where rapid population aging and increased longevity have led to a growing demand for complex healthcare decision-making.11 They face compounded challenges, including the accumulation of multiple chronic conditions, poorer overall health status, and age-related cognitive impairments, all of which may compromise the capacity to engage in and participate fully in decision-making processes.12 In addition, broader social and demographic changes, including shifts in family structures and caregiving patterns, may further influence the context in which these decisions occur.13 Tensions between cultural duties such as filial piety and individual patient autonomy are often especially pronounced, particularly in family-mediated or surrogate decision-making around serious illness and end-of-life care.9,14 These intersecting clinical, cultural, and relational factors highlight the importance of examining SDM not only at the level of individual communication skills but also within broader family and system-level dynamics.

East Asian contexts remain largely unrepresented in the existing literature on barriers and facilitators to SDM among older adults. A previous systematic review examining SDM among older adults with multiple chronic conditions identified several barriers and facilitators. Reported barriers included poor health, cognitive or physical impairments, and organizational constraints such as time pressure, whereas facilitators included explicitly inviting patients to participate in decision-making, emphasizing individual values and preferences, and supporting patient autonomy in clinical decisions.12 However, the studies included in that review were conducted primarily in Western countries, including the United States, European countries, and Australia, which may limit the applicability of these findings to East Asian contexts.12

In many East Asian societies, medical decision-making is shaped by collectivistic family norms and the moral weight of filial obligations, such that the family unit rather than the individual patient is often regarded as the primary locus of decision-making authority.15,16 These Confucian-derived norms of family harmony and filial piety have been shown to influence prognosis disclosure, advance care planning, and decisions about life-sustaining treatments, as well as the extent to which patient autonomy is foregrounded in clinical encounters.15,17 While some of these sociocultural features may also be observed in other parts of Asia, they have been particularly well described in East Asian contexts.15,18 These sociocultural characteristics may shape how SDM is practiced among older adults in East Asia, highlighting the need for a focused examination of SDM barriers and facilitators in this region.

The present scoping review aims to identify and categorize key barriers and facilitators to SDM within East Asian contexts. Specifically, this review seeks to answer the following research question: What barriers and facilitators to SDM for older adults have been reported in East Asian health systems, and how can they be categorized across key stakeholder domains (patients, caregivers, clinicians, and the health system)? By synthesizing the available evidence across these 4 critical domains, this review will provide a foundational evidence base for the development of culturally attuned models and intervention strategies tailored to aging populations in East Asia.