Involving clinician users in the design and development of Clinical Decision Support (CDS) systems is touted to improve the fit between system and user needs. However, the impact of clinician involvement on CDS acceptance and use in practice has not been systematically studied. This review aimed to identify the approaches taken to involve clinicians in CDS development and understand the impact of these approaches on barriers and facilitators to acceptance and use in hospital settings over time. Twenty-three studies met full inclusion criteria. Clinician involvement was rarely described in depth and no comparative studies were identified. Despite frequently reporting perceived ease of use, included studies still reported barriers to acceptance and use shortly after CDS implementation and years later. Future studies should report clinician involvement in adequate detail to enable understanding of its impact on CDS acceptance and use over time. Additional recommendations for future research, including conducting comparative studies and maintaining clinician involvement beyond implementation, are described.