Conclusion

This scoping review synthesizes evidence on barriers and facilitators to SDM among older adults in the East Asian healthcare systems and shows that SDM is shaped by interacting influences involving patients, caregivers, clinicians, and health systems. While several of these barriers and facilitators are consistent with those identified in Western contexts, the findings also highlight the important role of family involvement, clinician authority, and structural constraints in SDM for older adults in East Asia. The existing literature has focused largely on EOL care, LST decisions, and ACP, thereby narrowing current understandings of how SDM functions across the wider range of healthcare decisions encountered by older adults. Future research should therefore extend SDM inquiry beyond EOL contexts and explore how culturally responsive approaches that engage patients, families, clinicians, and health systems can support meaningful participation in everyday clinical decision-making across diverse care settings in East Asia.