Physicians' Perspective on Shared Decision-making：a
Qualitative Study

doi:10.12114/j.issn.1007-9572.2021.00.254

Abstract

Abstract: Background

Shared decision-making has promoted the transformation of the role of patients from passive recipients of health care to active participants and supervisors, deeply reflecting the idea of patient-centered care. Research on shared decision-making in China is still in its infancy. Physicians are major participants in decision-making, but their perspectives on shared decision-making have been rarely studied.

Objective

To explore physicians' perspective on shared decision-making, offering evidence for the implementation of shared decision-making.

Methods

From May to July 2020, we conducted semi-structured interviews with 15 physicians selected by convenience sampling method from a grade A tertiary hospital in Shanghai for investigating their actual decision-making process, their views and attitudes about shared decision-making, and the obstacles to clinical implementation of shared decision-making. The interview results were analyzed by Colaizzi's method of data analysis.

Results

Among the 15 physicians, 10 were male and 5 were female; aged 28-53 years old, with an average age of (38.4±7.0) years old; 4 residents, 5 attending physicians, 4 associate chief physicians, and 2 chief physicians; 5 physicians, 7 surgeons and 3 oncologists. Four themes including 15 subthemes were identified: differences in physicians thederstanding of policies related to shared decision-making; unclear understanding of physicians and patients' roles in shared decision-making; acknowledging the importance of shared decision-making; obstacles to clinical implementation of shared decision-making.

Conclusion

Our study suggests that improving physicians' understanding level of shared decision-making, and creating conditions facilitating clinical implementation of shared decision-making may promote the sound development of shared decision-making.

Key words: Decision making, shared, Cognition, Qualitative research

摘要： 背景

医患共享决策推动了患者角色从医疗照护的被动接受者向主动参与者和监督者的转变，深度贯彻了"以患者为中心"的理念。国内对医患共享决策的研究尚处于起步阶段，作为决策的主体之一，医生对医患共享决策认知的相关研究比较少。

目的

探索医生对医患共享决策的认知情况，为医患共享决策的实施提供依据。

方法

2020年5—7月，采用方便抽样法，对15名上海市某三级甲等医院的医生进行半结构式访谈，访谈内容包括医生实际的决策过程、医生对医患共享决策的理解及态度、医患共享决策实践中存在的阻碍因素，并采用Colaizzi七步分析法对访谈资料进行分析。

结果

15名被访谈医生中，男10名，女5名；年龄28~53岁，平均年龄（38.4±7.0）岁；住院医师4名，主治医师5名，副主任医师4名，主任医师2名；内科医生5名，外科医生7名，肿瘤科医生3名。共提炼出15个亚主题，可归纳为4个主题：医生对医患共享决策的认知偏差，对医患共享决策实施中的角色认知不明确，医生认同医患共享决策具有重要意义,医患共享决策实践存在阻碍因素。

结论

需提高医生对医患共享决策的认知水平，并创造临床实施医患共享决策的条件，以促进医患共享决策在临床的顺利开展。

关键词: 共同决策, 认知, 质性研究

CLC Number:

R395

YANG Linning, ZHENG Hongying, ZHAO Dan, YANG Yan.

Physicians' Perspective on Shared Decision-making：a Qualitative Study [J]. Chinese General Practice, 2022, 25(10): 1213-1219.

杨林宁,郑红颖,赵丹等. 医生对医患共享决策认知的质性研究[J]. 中国全科医学, 2022, 25(10): 1213-1219. DOI: 10.12114/j.issn.1007-9572.2021.00.254.

Figures/Tables 1

References 35

[1]	SCHOLL I，ZILL J M，HÄRTER M，et al. How do health services researchers understand the concept of patient-centeredness? Results from an expert survey[J]. Patient Prefer Adherence，2014，8：1153-1160. DOI：10.2147/PPA.S64051.
[2]	CHARLE C，GAFNI A，WHELA T. Shared decision-making in the medical encounter：what does it mean?（or it takes at least two to tango）[J]. Soc Sci Med，1997，44（5）：681-692. DOI：10.1016/s0277-9536(96)00221-3.
[3]	BARRY M J，EDGMAN-LEVITAN S. Shared decision making-pinnacle of patient-centered care[J]. N Engl J Med，2012，366（9）：780-781. DOI：10.1056/NEJMp1109283.
[4]	陈化，刘俊荣. 从知情同意到共同决策：临床决策伦理的范式转移——从Montgomery案例切入[J]. 医学与哲学，2017，38（19）：16-19. DOI：10.12014/j.issn.1002-0772.2017.10a.07.
[5]	ERNST J，KUHNT S，SCHWARZER A，et al. The desire for shared decision making among patients with solid and hematological cancer[J]. Psychooncology，2011，20（2）：186-193. DOI：10.1002/pon.1723.
[6]	KANE H L，HALPERN M T，SQUIERS L B，et al. Implementing and evaluating shared decision making in oncology practice[J]. CA Cancer J Clin，2014，64（6）：377-388. DOI：10.3322/caac.21245.
[7]	FROSCH D L，MOULTON B W，WEXLER R M，et al. Shared decision making in the United States：policy and implementation activity on multiple fronts[J]. Z Evid Fortbild Qual Gesundhwes，2011，105（4）：305-312. DOI：10.1016/j.zefq.2011.04.004.
[8]	HUANG R，GIONFRIDDO M R，ZHANG L，et al. Shared decision-making in the People's Republic of China：current status and future directions[J]. Patient Prefer Adherence，2015，9：1129-1141. DOI：10.2147/PPA.S82110.
[9]	ZEUNER R，FROSCH D L，KUZEMCHAK M D，et al. Physicians' perceptions of shared decision-making behaviours：a qualitative study demonstrating the continued chasm between aspirations and clinical practice[J]. Health Expect，2015，18（6）：2465-2476. DOI：10.1111/hex.12216.
[10]	KING V J，DAVIS M M，GORMAN P N，et al. Perceptions of shared decision making and decision aids among rural primary care clinicians[J]. Med Decis Making，2012，32（4）：636-644. DOI：10.1177/0272989X11431961.
[11]	HOFSTEDE S N，MARANG-VAN DE MHEEN P J，WENTINK M M，et al. Barriers and facilitators to implement shared decision making in multidisciplinary sciatica care：a qualitative study[J]. Implement Sci，2013，8：95. DOI：10.1186/1748-5908-8-95.
[12]	EDWARD K L，WELCH T. The extension of Colaizzi's method of phenomenological enquiry[J]. Contemp Nurse，2011，39（2）：163-171. DOI：10.5172/conu.2011.163.
[13]	SCHOENFELD E M，GOFF S L，ELIA T R，et al. A qualitative analysis of attending physicians' use of shared decision-making：implications for resident education[J]. J Grad Med Educ，2018，10（1）：43-50. DOI：10.4300/JGME-D-17-00318.1.
[14]	FRERICHS W，HAHLWEG P，MULLER E，et al. Shared decision-making in oncology：a qualitative analysis of healthcare providers' views on current practice[J]. PLoS One，2016，11（3）：e149789. DOI：10.1371/journal.pone.0149789.
[15]	张新庆. 医患"共享决策"核心概念解析[J]. 医学与哲学，2017，38（19）：12-15，61. DOI：10.12014/j.issn.1002-0772.2017.10a.06.
[16]	LEGARE F，WITTEMAN H O. Shared decision making：examining key elements and barriers to adoption into routine clinical practice[J]. Health Aff（Millwood），2013，32（2）：276-284. DOI：10.1377/hlthaff.2012.1078.
[17]	CHUNG M C，JUANG W C，LI Y C. Perceptions of shared decision making among health care professionals[J]. J Eval Clin Pract，2019，25（6）：1080-1087. DOI：10.1111/jep.13249.
[18]	LEGARE F，ST-JACQUES S，GAGNON S，et al. Prenatal screening for down syndrome：a survey of willingness in women and family physicians to engage in shared decision-making[J]. Prenat Diagn，2011，31（4）：319-326. DOI：10.1002/pd.2624.
[19]	DIOUF N T，MENEAR M，ROBITAILLE H，et al. Training health professionals in shared decision making：update of an international environmental scan[J]. Patient Educ Couns，2016，99（11）：1753-1758. DOI：10.1016/j.pec.2016.06.008.
[20]	顾莉莉，叶旭春，崔静，等. 医生角色认知研究现状的分析与思考[J]. 解放军护理杂志，2015，32（7）：30-32. DOI：10.3969/j.issn.1008-9993.2015.07.009.
[21]	STIGGELBOUT A M，PIETERSE A H，DE HAES J C J M. Shared decision making：concepts，evidence，and practice[J]. Patient Educ Couns，2015，98（10）：1172-1179. DOI：10.1016/j.pec.2015.06.022.
[22]	BOMHOF-ROORDINK H，GARTNER F R，STIGGELBOUT A M，et al. Key components of shared decision making models：a systematic review[J]. BMJ Open，2019，9（12）：e31763. DOI：10.1136/bmjopen-2019-031763.
[23]	KAHVECI R，AYHAN D，DONER P，et al. Shared decision-making in pediatric intensive care units：a qualitative study with physicians，nurses and parents[J]. Indian J Pediatr，2014，81（12）：1287-1292. DOI：10.1007/s12098-014-1431-6.
[24]	FROSCH D L，MAY S G，RENDLE K A，et al. Authoritarian physicians and patients' fear of being labeled 'difficult' among key obstacles to shared decision making[J]. Health Aff（Millwood），2012，31（5）：1030-1038. DOI：10.1377/hlthaff.2011.0576.
[25]	STREET R J，HAIDET P. How well do doctors know their patients? Factors affecting physician understanding of patients' health beliefs[J]. J Gen Intern Med，2011，26（1）：21-27. DOI：10.1007/s11606-010-1453-3.
[26]	KARNIELI-MILLER O，EISIKOVITS Z. Physician as partner or salesman? Shared decision-making in real-time encounters[J]. Soc Sci Med，2009，69（1）：1-8. DOI：10.1016/j.socscimed.2009.04.030.
[27]	POLITI M C，DIZON D S，FROSCH D L，et al. Importance of clarifying patients' desired role in shared decision making to match their level of engagement with their preferences[J]. BMJ，2013，347：f7066. DOI：10.1136/bmj.f7066.
[28]	LEGARE F，RATTE S，GRAVEL K，et al. Barriers and facilitators to implementing shared decision-making in clinical practice：update of a systematic review of health professionals' perceptions[J]. Patient Educ Couns，2008，73（3）：526-535. DOI：10.1016/j.pec.2008.07.018.
[29]	YAO M，FINNIKIN S，CHENG K K. Call for shared decision making in China：challenges and opportunities[J]. Z Evid Fortbild Qual Gesundhwes，2017，123/124：32-35. DOI：10.1016/j.zefq.2017.05.004.
[30]	SHEPHERD H L，BARRATT A，TREVENA L J，et al. Three questions that patients can ask to improve the quality of information physicians give about treatment options：a cross-over trial[J]. Patient Educ Couns，2011，84（3）：379-385. DOI：10.1016/j.pec.2011.07.022.
[31]	VAN VEENENDAAL H，VAN DER WEIJDEN T，UBBINK D T，et al. Accelerating implementation of shared decision-making in the Netherlands：an exploratory investigation[J]. Patient Educ Couns，2018，101（12）：2097-2104. DOI：10.1016/j.pec.2018.06.021.
[32]	SIMMONS M B，HETRICK S E，JORM A F. Making decisions about treatment for young people diagnosed with depressive disorders：a qualitative study of clinicians' experiences[J]. BMC Psychiatry，2013，13：335. DOI：10.1186/1471-244X-13-335.
[33]	LEGARE F，THOMPSON-LEDUC P. Twelve myths about shared decision making[J]. Patient Educ Couns，2014，96（3）：281-286. DOI：10.1016/j.pec.2014.06.014.
[34]	杨学诗，康艳楠，魏文彤，等. 我国医方视角下医患信任关系现状系统评价[J]. 中国医院，2021，25（3）：19-23. DOI：10.19660/j.issn.1671-0592.2021.3.06.
[35]	LEGARE F，STACEY D，FOREST P G，et al. Moving SDM forward in Canada：milestones，public involvement，and barriers that remain[J]. Z Evid Fortbild Qual Gesundhwes，2011，105（4）：245-253. DOI：10.1016/j.zefq.2011.04.011.