Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, P.O. Box 505055, Dubai, United Arab Emirates.
Hum Resour Health. 2020 May 7;18(1):33. doi: 10.1186/s12960-020-00475-x.
Shared decision-making (SDM) is an integral part of patient-centered delivery of care. Maximizing the opportunity of patients to participate in decisions related to their health is an expectation in care delivery nowadays. The purpose of this study is to explore the perceptions of physicians in regard to SDM in a large private hospital network in Dubai, United Arab Emirates.
This study utilized a cross-sectional design, where a survey questionnaire was assembled to capture quantitative and qualitative data on the perception of physicians in relation to SDM. The survey instrument included three sections: the first solicited physicians' personal and professional information, the second entailed a 9-item SDM Questionnaire (SDM-Q-9), and the third included an open-ended section. Statistical analysis assessed whether the average SDM-Q-9 score differed significantly by gender, age, years of experience, professional status-generalist versus specialist, and work location-hospitals versus polyclinics. Non-parametric analysis (two independent variables) with the Mann-Whitney test was utilized. The qualitative data was thematically analyzed.
Fifty physicians from various specialties participated in this study (25 of each gender-85% response rate). Although the quantitative data analysis revealed that most physicians (80%) rated themselves quite highly when it comes to SDM, qualitative analysis underscored a number of barriers that limited the opportunity for SDM. Analysis identified four themes that influence the acceptability of SDM, namely physician-specific (where the physicians' extent of adopting SDM is related to their own belief system and their perception that the presence of evidence negates the need for SDM), patient-related (e.g., patients' unwillingness to be involved in decisions concerning their health), contextual/environmental (e.g., sociocultural impediments), and relational (the information asymmetry and the power gradient that influence how the physician and patient relate to one another).
SDM and evidence-based management (EBM) are not mutually exclusive. Professional learning and development programs targeting caregivers should focus on the consolidation of the two perspectives. We encourage healthcare managers and leaders to translate declared policies into actionable initiatives supporting patient-centered care. This could be achieved through the dedication of the necessary resources that would enable SDM, and the development of interventions that are designed both to improve health literacy and to educate patients on their rights.
共同决策（SDM）是患者为中心的医疗服务的一个组成部分。最大限度地让患者有机会参与与他们的健康相关的决策，这是当今医疗服务的期望。本研究的目的是探讨在阿拉伯联合酋长国迪拜的一家大型私立医院网络中，医生对 SDM 的看法。
本研究采用横断面设计，编制了一份调查问卷，以获取关于医生对 SDM 的看法的定量和定性数据。调查工具包括三个部分：第一部分征求医生的个人和专业信息，第二部分包括 9 项 SDM 问卷（SDM-Q-9），第三部分包括一个开放式部分。统计分析评估了平均 SDM-Q-9 得分是否因性别、年龄、经验年限、专业身份（全科医生与专科医生）以及工作地点（医院与诊所）而有显著差异。采用非参数分析（两个独立变量）和 Mann-Whitney 检验。对定性数据进行主题分析。
来自不同专业的 50 名医生参与了这项研究（男女各 25 名，回应率为 85%）。尽管定量数据分析显示，大多数医生（80%）在 SDM 方面自我评价很高，但定性分析强调了一些限制 SDM 机会的障碍。分析确定了影响 SDM 可接受性的四个主题，即医生特定的（医生采用 SDM 的程度与他们自己的信仰体系以及他们认为证据的存在否定了 SDM 的必要性有关）、患者相关的（例如，患者不愿意参与与他们的健康相关的决策）、上下文/环境相关的（例如，社会文化障碍）和关系相关的（信息不对称和权力梯度，影响医生和患者彼此之间的关系）。
SDM 和循证管理（EBM）并非相互排斥。针对护理人员的专业学习和发展计划应侧重于巩固这两个观点。我们鼓励医疗保健管理人员和领导者将宣布的政策转化为支持以患者为中心的医疗服务的可操作举措。这可以通过投入必要的资源来实现，这些资源将使 SDM 成为可能，并制定旨在提高健康素养和教育患者权利的干预措施。
