Shared decision-making is a practice that fully reflects the idea of patient-centered care, but its clinical implementation process is not ideal. Physicians are main participants to promote the implementation of shared decision-making, but there are few studies on their behaviors in shared decision-making.

To explore the process and main behavioral characteristics of physicians' participation in shared decision-making, offering evidence for the promotion and implementation of shared decision-making in clinical practice.

A mixed-methods convergent design was used to collect quantitative and qualitative data. In the quantitative study, convenience sampling method was used to select in-service physicians (n=360) from a grade A tertiary hospital in Shanghai to attend a questionnaire survey from May to December 2020 to understand the status of their participation in shared decision-making. K-means clustering was conducted to analyze the distribution characteristics of physicians' participation in shared decision-making. In the qualitative study, 23 physicians selected from the participants of the quantitative study using convenience sampling and purposive sampling from June to December 2020 were recruited to attend semi-structured interviews to explore the process and experience of their participation in shared decision-making and identify the main behavioral characteristics of them in each part of the process of shared decision-making.

Quantitative data analysis: in all, 325 (90.3%) of the physicians who returned responsive questionaries were included for analysis. The average total score of their participation behavior in shared decision-making was (80.44±14.88) . The further analysis found that physicians had the highest participation in behaviors of "Explain the advantages and disadvantages of the treatment options to my patient" (4.38±0.74) and "I told my patient that there are different options for treating his/her medical condition" (4.30±0.84) ; physicians had the lowest participation in behaviors of "I made clear to my patient that a shared decision needs to be made" (3.72±1.22) and "My patient and I selected a treatment option together" (3.74±1.03) . The results of cluster analysis showed that the behavioral characteristics of physicians' participation in shared decision-making could be divided into three groups, namely informed consent group, partial patient participation group and shared decision-making group. Qualitative data analysis: physicians' participation behaviors in shared decision-making included building up the awareness of shared decision-making, providing the patient with information, examining patient comprehension of the information, clarifying patient values, co-assessment (of the feasibility of the options) , reaching a decision and decision implementation. Analysis of the mixed-methods research results showed that in the decision-making process, physicians paid more attention to the provision of information, and ignored the behavioral factors of promoting patient participation at the level of doctor-patient communication. The behavioral characteristics of physicians' participation in shared decision-making were different.

The physicians' participation behavior in shared decision-making was limited. And they may have misunderstandings about the behavior process of shared decision-making. To promote the practical implementation of shared decision-making in clinical practice, it is suggested to help physicians clarify the process of shared decision-making via interventions enhancing their knowledge and attitudes regarding shared decision-making, deepen their understanding of shared decision-making through scenario simulation and role-playing, and improve their recognition of patient values in decision-making.