ORIGINAL PAPER
Healthcare professionals' views on factors influencing shared decision-making in primary health care centres in Saudi Arabia: A qualitative study
Nouf Alsulamy MSc,
Andrew Lee MD,
Praveen Thokala PhD,
Corresponding Author
Nouf Alsulamy MSc
Public Health, The University of Sheffield, Sheffield, UK
College of Business, University of Jeddah, Jeddah, Saudi Arabia
Correspondence
Nouf Alsulamy, School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK.
Email: [email protected]
Search for more papers by this authorAndrew Lee MD
Public Health, The University of Sheffield, Sheffield, UK
Search for more papers by this authorPraveen Thokala PhD
Health Economics and Decision Science, The University of Sheffield, Sheffield, UK
Search for more papers by this authorNouf Alsulamy MSc,
Andrew Lee MD,
Praveen Thokala PhD,
Corresponding Author
Nouf Alsulamy MSc
Public Health, The University of Sheffield, Sheffield, UK
College of Business, University of Jeddah, Jeddah, Saudi Arabia
Correspondence
Nouf Alsulamy, School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK.
Email: [email protected]
Search for more papers by this authorAndrew Lee MD
Public Health, The University of Sheffield, Sheffield, UK
Search for more papers by this authorPraveen Thokala PhD
Health Economics and Decision Science, The University of Sheffield, Sheffield, UK
Search for more papers by this authorAbstract
Objective
To describe the perspectives of healthcare professionals regarding the implementation of Shared decision-making (SDM) in primary healthcare centres (PHCCs) in Saudi Arabia.
Methods
Qualitative semi-structured interviews were conducted with a purposive and snowball sample of healthcare professionals in PHCCs. Interviews have been recorded, transcribed, translated and thematically analysed. Themes were mapped to the COM-B model.
Results
Sixteen healthcare professionals were interviewed. The data analysis identified six themes and 14 sub-themes. The six themes are patient related factors, health professional related factors, environmental context and resources, patient–physician communication, patient–physician preferences toward SDM and physicians' perceived value and benefits of SDM. Physicians are unlikely to practice SDM in the context of time pressures, shortage of physicians, lack of treatment options, and decision-making aids. The findings also underscored the importance of building a trustworthy physician-patient relationship through the use of effective conversation techniques.
Conclusions
There are multiple barriers to SDM in primary care. Unless these barriers are addressed, it is unlikely that physicians will effectively or fully engage in SDM with patients.
CONFLICT OF INTEREST
The authors have no conflicts of interest.
Open Research
DATA AVAILABILITY STATEMENT
Research data are not shared.
Supporting Information
| Filename | Description |
|---|---|
| JEP13616-sup-0001-SupinfoS1.docxWord 2007 document , 18.1 KB | Supporting information 1. COREQ checklist. |
| JEP13616-sup-0002-SupinfoS2.docxWord 2007 document , 21 KB | Supporting information 2. Topic guide copy. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
REFERENCES
- 1Epstein RM, Street RL Jr. The values and value of patient-centered care. Ann Fam Med. 2011; 9(2): 100-103. https://doi.org/10.1370/afm.1239
- 2Barry MJ, Edgman-levitan S. Shared decision making — the pinnacle of patient-centered care. N Engl J Med. 2012; 366(9): 780-781.
- 3Weston WW. Informed and shared decision-making: the crux of patient-centered care. CMAJ. 2001; 165(4): 438-439.
- 4Menear M, Garvelink MM, Adekpedjou R, et al. Factors associated with shared decision making among primary care physicians: findings from a multicentre cross-sectional study. Health Expect. 2018; 21(1): 212-221. https://doi.org/10.1111/hex.12603
- 5Moulton B, King JS. Aligning ethics with medical decision-making: the quest for informed patient choice. J Law Med Ethics. 2010; 38: 85-97. https://doi.org/10.1111/j.1748-720X.2010.00469.x
- 6Frosch DL, Kaplan RM. Shared decision making in clinical medicine: past research and future directions. Am J Prev Med. 1999; 17(4): 285-294. https://doi.org/10.1016/s0749-3797(99)00097-5
- 7O'Connor AM, Wennberg JE, Legare F, et al. Toward the “tipping point”: decision aids and informed patient choice. Health Aff. 2007; 26(3): 716-725. https://doi.org/10.1377/hlthaff.26.3.716
- 8Coulter A, Collins A. In: E Rowling, ed. Making Shared Decision- Making a Reality. No Decision about Me, without Me. London, England: The King's Fund; 2011. www.kingsfund.org.uk
- 9O'Connor AM, Stacey D, Entwistle V. Decision aids for people facing health treatment or screening decisions. Cochrane Libr. 2017; 4. https://doi.org/10.1002/14651858.CD001431.pub2
10.1002/14651858.CD001431.pub2 Google Scholar
- 10Murray E, Burns J, See Tai S, Lai R, Nazareth I. Interactive health communication applications for people with chronic disease. Cochrane Libr. 2005; 4. https://doi.org/10.1002/14651858.CD004274.pub4
10.1002/14651858.CD004274.pub4 Google Scholar
- 11Scheibler F, Janssen C, Pfaff H. Shared decision making: an overview of international research literature. Soz Praventivmed. 2003; 48(1): 11-23.
- 12 The Health Foundation. Leading the way to shared decision making; 2012.
- 13Legare F, Ratte S, Stacey D, et al. Interventions for improving the adoption of shared decision making by healthcare professionals. Cochrane Database Syst Rev. 2010; 12(5):CD006732. https://doi.org/10.1002/14651858.CD006732.pub2
10.1002/14651858.CD006732.pub2 Google Scholar
- 14Durand M-A, Barr PJ, Walsh T, Elwyn G. Incentivizing shared decision making in the USA–where are we now? Heal. 2015; 3(2): 97-101. https://doi.org/10.1016/j.hjdsi.2014.10.008
10.1016/j.hjdsi.2014.10.008 Google Scholar
- 15Härter M, van der Weijden T, Elwyn G. Policy and practice developments in the implementation of shared decision making: an international perspective. Z Evid Fortbild Qual Gesundhwes. 2011; 105(4): 229-233. https://doi.org/10.1016/j.zefq.2011.04.018
- 16Légaré F, Stacey D, Forest P-G, Coutu M-F. Moving SDM forward in Canada: milestones, public involvement, and barriers that remain. Z Evid Fortbild Qual Gesundhwes. 2011; 105(4): 245-253. https://doi.org/10.1016/j.zefq.2011.04.011
- 17Braddock CH 3rd, Fihn SD, Levinson W, Jonsen AR, Pearlman RA. How doctors and patients discuss routine clinical decisions. Informed decision making in the outpatient setting. J Gen Intern Med. 1997; 12(6): 339-345. https://doi.org/10.1046/j.1525-1497.1997.00057.x
- 18Elwyn G, Edwards A, Kinnersley P. Shared decision-making in primary care: the neglected second half of the consultation. Br J Gen Pr. 1999; 49(443): 477-482. https://pubmed.ncbi.nlm.nih.gov/10562751
- 19Godolphin W, Towle A, McKendry R. Challenges in family practice related to informed and shared decision-making: a survey of preceptors of medical students. CMAJ. 2001; 165(4): 434-435.
- 20Legare F, Stacey D, Turcotte S, et al. Interventions for improving the adoption of shared decision making by healthcare professionals. Cochrane Database Syst Rev. 2014; 15(9):CD006732. https://doi.org/10.1002/14651858.CD006732.pub3
10.1002/14651858.CD006732.pub3 Google Scholar
- 21Coulter A, Peto V, Doll H. Patients' preferences and general practitioners' decisions in the treatment of menstrual disorders. Fam Pr. 1994; 11(1): 67-74. https://doi.org/10.1093/fampra/11.1.67
- 22Strull WM, Lo B, Charles G. Do patients want to participate in medical decision making? JAMA. 1984; 252(21): 2990-2994.
- 23Légaré F, Stewart M, Frosch D, et al. EXACKTE(2): exploiting the clinical consultation as a knowledge transfer and exchange environment: a study protocol. Implement Sci. 2009; 4: 14. https://doi.org/10.1186/1748-5908-4-14
- 24Green LA, Fryer GEJ, Yawn BP, Lanier D, Dovey SM. The ecology of medical care revisited. N Engl J Med. 2001; 344(26): 2021-2025. https://doi.org/10.1056/NEJM200106283442611
- 25Murray E, Charles C, Gafni A. Shared decision-making in primary care: tailoring the Charles et al. model to fit the context of general practice. Patient Educ Couns. 2006; 62(2): 205-211. https://doi.org/10.1016/j.pec.2005.07.003
- 26Montori VM, Gafni A, Charles C. A shared treatment decision-making approach between patients with chronic conditions and their clinicians: the case of diabetes. Health Expect. 2006; 9(1): 25-36. https://doi.org/10.1111/j.1369-7625.2006.00359.x
- 27Couët N, Desroches S, Robitaille H, et al. Assessments of the extent to which health-care providers involve patients in decision making: a systematic review of studies using the OPTION instrument. Health Expect. 2015; 18(4): 542-561. https://doi.org/10.1111/hex.12054
- 28Elwyn G, Scholl I, Tietbohl C, et al. “Many miles to go.”: a systematic review of the implementation of patient decision support interventions into routine clinical practice. BMC Med Inf Decis Mak. 2013; 13(SUPPL. 2): 1472–6947. https://doi.org/10.1186/1472-6947-13-S2-S14
10.1186/1472-6947-13-S2-S14 Google Scholar
- 29Obeidat RF, Homish GG, Lally RM. Shared decision making among individuals with cancer in non-western cultures: a literature review. Oncol Nurs Forum. 2013; 40(5): 454-463. https://doi.org/10.1188/13.ONF.454-463
- 30Alsulamy N, Lee A, Thokala P, Alessa T. Views of stakeholders on factors influencing shared decision-making in the eastern Mediterranean region: a systematic review. East Mediterr Heal J. 2021; 27(3): 300-311. https://doi.org/10.26719/emhj.20.139
- 31 Ministry of Health. Patient Rights and Responsibilities Document; 2019. https://www.moh.gov.sa/en/HealthAwareness/EducationalContent/HealthTips/Pages/001.aspx
- 32Mobeireek AF, Mobeireek AF. Information disclosure and decision-making: the Middle East versus the Far East and the information disclosure and decision-making: the Middle East versus the Far East and the West. J Med Ethics. 2008; 34: 225-229. https://doi.org/10.1136/jme.2006.019638
- 33 The Ministry of Health. Healthcare Transformation Strategy. doi:https://doi.org/10.1007/978-3-540-71868-0_17
10.1007/978-3-540-71868-0_17 Google Scholar
- 34Alsulamy N, Lee A, Thokala P, Alessa T. What influences the implementation of shared decision making: an umbrella review. Patient Educ Couns. 2020; 103(12): 2400-2407. https://doi.org/10.1016/j.pec.2020.08.009
- 35Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011; 6: 42. https://doi.org/10.1186/1748-5908-6-42
- 36Elwyn G, Frosch DL, Kobrin S. Implementing shared decision-making: consider all the consequences. Implement Sci. 2016; 11(1): 114. https://doi.org/10.1186/s13012-016-0480-9
- 37Mathijssen EGE, van den Bemt BJF, Wielsma S, van den Hoogen FHJ, Vriezekolk JE. Exploring healthcare professionals' knowledge, attitudes and experiences of shared decision making in rheumatology. RMD Open. 2020; 6(1):e001121. https://doi.org/10.1136/rmdopen-2019-001121
- 38Légaré F, Witteman HO. Shared decision making: examining key elements and barriers to adoption into routine clinical practice. Health Aff. 2013; 32(2): 276-284. https://doi.org/10.1377/hlthaff.2012.1078
- 39Hamann J, Langer B, Winkler V, Busch R, Cohen R, Leucht S. Shared decision making for in-patients with schizophrenia. Acta Psychiatr Scand. 2006; 144(4): 265-273. https://doi.org/10.1111/j.1600-0447.2006.00798.x
10.1111/j.1600-0447.2006.00798.x Google Scholar
- 40Cruz M, Pincus HA. Research on the influence that communication in psychiatric encounters has on treatment. Psychiatr Serv. 2002; 53(10): 1253-1265.
- 41Loh A, Simon D, Hennig K, Hennig B, Härter M, Elwyn G. The assessment of depressive patients' involvement in decision making in audio-taped primary care consultations. Patient Educ Couns. 2006; 63(3): 314-318. https://doi.org/10.1016/j.pec.2006.04.006
- 42Tong WT, Lee YK, Ng CJ, Lee PY. Factors influencing implementation of a patient decision aid in a developing country: an exploratory study. Implement Sci. 2017; 12(1): 1-12. https://doi.org/10.1186/s13012-017-0569-9
- 43Silvia KA, Ozanne EM, Sepucha KR. Implementing breast cancer decision aids in community sites: barriers and resources. Health Expect. 2008; 11(1): 46-53. https://doi.org/10.1111/j.1369-7625.2007.00477.x
- 44Stacey D, Chambers SK, Jacobsen MJ, Dunn J. Overcoming barriers to cancer-helpline professionals providing decision support for callers: an implementation study. Oncol Nurs Forum. 2008; 35(6): 961-969. https://doi.org/10.1188/08.ONF.961-969
- 45Stacey D, Vandemheen KL, Hennessey R, et al. Implementation of a cystic fibrosis lung transplant referral patient decision aid in routine clinical practice: an observational study. Implement Sci. 2015; 10: 17. https://doi.org/10.1186/s13012-015-0206-4
- 46van Walraven C, Taljaard M, Bell CM, et al. Information exchange among physicians caring for the same patient in the community. CMAJ. 2008; 179(10): 1013-1018. https://doi.org/10.1503/cmaj.080430
- 47Agoritsas T, Heen AF, Brandt L, et al. Decision aids that really promote shared decision making: the pace quickens. BMJ. 2015; 350:g7624. https://doi.org/10.1136/bmj.g7624
- 48Kasper J, Légaré F, Scheibler F, Geiger F. Turning signals into meaning—‘shared decision making’ meets communication theory. Health Expect. 2012; 15(1): 3-11. https://doi.org/10.1111/j.1369-7625.2011.00657.x
- 49Politi MC, Han PKJ, Col NF. Communicating the uncertainty of harms and benefits of medical interventions. Med Decis Making. 2007; 27(5): 681-695. https://doi.org/10.1177/0272989X07307270
- 50Leydon GM, Boulton M, Moynihan C, et al. Cancer patients' information needs and information seeking behaviour: in depth interview study. BMJ. 2000; 320(7239): 909-913. https://doi.org/10.1136/bmj.320.7239.909
- 51Charles C, Gafni A, Bm TW, Frcp C. Self-reported use of shared decision-making among breast cancer specialists and perceived barriers and facilitators to implementing this approach. Health Expect. 2004; 7(4): 338-348.
- 52Chewning B, Bylund CL, Shah B, Arora NK, Gueguen JA, Makoul G. Patient preferences for shared decisions: a systematic review. Patient Educ Couns. 2012; 86(1): 9-18. https://doi.org/10.1016/j.pec.2011.02.004
