Owino Ranga Solomon, Kituuka Olivia, Kutyabami Paul, Sewankambo Nelson K
Makerere University Lung Institute, Kampala, Uganda.
School of Medicine, Makerere University, Kampala, Uganda.
BMC Med Ethics. 2025 Jan 27;26(1):13. doi: 10.1186/s12910-025-01172-x.
Shared decision-making in healthcare is a collaborative process where patients are supported to make informed decisions according to their preferences. Healthcare decisions affect patients' lives which necessitates patients to participate in decisions concerning their health. This study explored experiences and ethical issues related to shared decision-making in a rural healthcare setting.
An exploratory qualitative study was conducted at Budumba Health Centre III and Butaleja Health Centre III in rural Eastern Uganda. In this study, 23 in-depth interviews were conducted among 12 healthcare providers and 11 patients. Data was analyzed thematically using NVivo-12 plus software.
Four themes emerged which included: Paternalistic cultures of care, challenges, strategies for improvement, and ethical issues. Patients at both facilities expressed the need to be involved in decision-making processes. However, many stressed that they are not engaged in decision-making about their health. Many healthcare providers noted that shared decision-making could improve patient prognosis but are faced with challenges related to low male involvement and the influence of cultural and religious practices, including myths and patriarchal attitudes which impact effective patient engagement. Ethical issues identified include concerns about informed consent, privacy and confidentiality, deception, and harm.
This study highlighted the need for better sensitization of patients and comprehensive training for healthcare providers to minimize and resolve ethical issues that emerge during shared decision-making processes. Therefore, targeted interventions are needed to enhance decision-making processes in rural healthcare including but not limited to developing shared decision-making manual and continuous training of healthcare providers to ethically engage patients. Further research is needed to explore larger facilities with a bigger scope including patients under 18 years of age and and their surrogates.
医疗保健中的共同决策是一个协作过程，在此过程中，患者会得到支持，以便根据自己的偏好做出明智的决策。医疗决策会影响患者的生活，这就要求患者参与有关自身健康的决策。本研究探讨了农村医疗环境中与共同决策相关的经历和伦理问题。
在乌干达东部农村的布顿巴三级保健中心和布塔莱贾三级保健中心进行了一项探索性定性研究。在本研究中，对12名医疗服务提供者和11名患者进行了23次深入访谈。使用NVivo-12 plus软件对数据进行了主题分析。
出现了四个主题，包括：家长式的护理文化、挑战、改进策略和伦理问题。两个机构的患者都表示需要参与决策过程。然而，许多人强调他们没有参与关于自身健康的决策。许多医疗服务提供者指出，共同决策可以改善患者的预后，但面临着男性参与度低以及文化和宗教习俗影响的挑战，包括影响患者有效参与的神话和男权态度。确定的伦理问题包括对知情同意、隐私和保密、欺骗和伤害的担忧。
本研究强调需要更好地提高患者的认知度，并对医疗服务提供者进行全面培训，以尽量减少和解决共同决策过程中出现的伦理问题。因此，需要有针对性的干预措施来加强农村医疗保健中的决策过程，包括但不限于编写共同决策手册和对医疗服务提供者进行持续培训，以使患者在伦理层面参与进来。需要进一步研究，以探索规模更大、范围更广的机构，包括18岁以下的患者及其代理人。
