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.

医患共享决策是"以患者为中心"的重要体现形式之一，其临床实施过程并不理想，医生是推进医患共享决策实施过程的主体之一，但目前鲜见对共享决策过程中医生行为的研究。

探讨医生参与医患共享决策的过程及主要的行为特征，为医患共享决策在临床的推广和应用提供依据。

采用混合方法研究的聚敛式设计，同时收集定量数据和定性数据。定量研究采用方便抽样法，于2020年5—12月选取上海市某三级甲等医院的在职临床医生360例进行问卷调查，探索医生参与共享决策的现况，并对医生参与共享决策的行为进行K-均值聚类，分析医生共享决策行为的分布特征；定性研究采用方便抽样和目的抽样法，于2020年6—12月选取定量研究中的23例医生进行半结构式访谈，探索医生参与共享决策的过程和体验，明确医生在决策各环节的主要行为特征。

定量研究结果：325例（90.3%）医生的问卷被有效回收，参与共享决策行为的平均得分为（80.44±14.88）分。医生在解释治疗方案优缺点〔（4.38±0.74）分〕、提供多种治疗方案〔（4.30±0.84）分〕两项行为上的参与度较高，在告诉患者需要共同做一个重要的决定〔（3.72±1.22）分〕、共同决定选择某一治疗方案〔（3.74±1.03）分〕两项行为上的参与度较低；聚类分析结果显示，医生参与共享决策的行为特征可分为3组，分别为"知情同意组""患者部分参与组""共享决策组"。定性研究结果：医患共享决策过程中医生的参与行为包括创建决策意识，提供信息，检查患者对信息的理解，澄清患者价值观，共同权衡（治疗方案的评价），决策制定与实施。混合研究结果：在决策进程中，医生更关注信息的提供，忽视了医患沟通层面促进患者参与的行为要素，医生参与共享决策的各行为特征不同。

医患共享决策的行为是有限实施的，医生对共享决策的行为过程存在误解。可从知识和态度层面入手，帮助医生明晰共享决策的过程，通过情景模拟、角色扮演等方式加深医生对共享决策的认识和理解，提高其对患者决策价值的认同，从而推动医患共享决策在临床的真正实施。