Assessing shared decision-making in clinical practice: a systematic review and meta-analysis of studies using OPTION-12 and OPTION-5

Objectives Observing Patient Involvement in Decision Making (OPTION)-12 and OPTION-5 assess the extent to which observers score healthcare professionals’ (HCPs) involvement of patients in shared decision-making (SDM). We systematically reviewed studies measuring the extent to which HCPs involve patients in the decision-making process using the OPTION instrument. Design Informed by Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we updated a previous systematic review and included new studies reporting OPTION-12 or OPTION-5 scores from recordings of real-world clinical encounters, involving patients and HCPs making healthcare-related decisions. Searches were conducted across PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science databases (2012–2025), supplemented by citation screening and outreach to professional networks. We extracted study characteristics, OPTION version, psychometric data and item-level score details. We also assessed the study quality using the reports of rating procedures and conducted meta-analyses, subgroup analyses using a priori hypotheses and completed meta-regressions. Results In total, 174 studies were included, comprising almost 20 000 clinical consultations: 102 studies used only OPTION-12 and 64 used only OPTION-5, while four studies reported using both scales. Mean OPTION-12 and OPTION-5 score for studies unaffected by interventions were 25.1 (95% CI 22.1 to 28.2, k=76, I 2 =99.71%) and 31.8 (95% CI 26.6 to 37.1, k=42, I 2 =99.55%), respectively. Subgroup analyses revealed significantly higher scores in studies with postintervention OPTION-scores for both OPTION-12 (38.4 vs 25.1, p