Shared clinical decision making

ىضرلما تابغرو تاهجو ديدتح ىلإ ةساردلا هذه فدهت :فادهلأا جلاعب صالخا يبطلا رارقلا ذاختا يف مهتكراشم ىدم صوصخب .تابغرلا كلت ديدتح يف ةرثؤلما لماوعلا ةساردو ةيحصلا مهلكاشم ىربكلا ةلئاعلا بط زكارم دحأ يف ةيعطقم ةسارد تيرجأ :ةقيرطلا ةيدوعسلا ةيبرعلا ةكلملما ،ضايرلا ،ةيبطلا زيزعلادبع كللما ةنيدم يف ليلحتلا جذونم مادختسا تمو .م2012 ويام ىلإ سرام نم ةرتفلا يف .ىضرلما تابغر ديدتح يف ةرثؤلما لماوعلا ديدحتل ددعتلما يفوحتلا رارقلا ذاختا طنم ناك .اًضيرم 236 ةساردلا يف كراش :جئاتنلا ،)57%( »كراشلما طمنلا« وه ينكراشلما ةحيرش ىدل لضفلما يبطلا »يكلاهتسلاا« طمنلا ناك اميف )28%( عقاوب »يوبلأا« طمنلا هعبت وه »كراشلما طمنلا« ناك .)14%( عقاوب ينكراشلما ىدل لقلأا وه ووذو روكذلا ىضرلما ىدل ةربتعم ةيئاصحا ةللادبو لضفلما طمنلا رابك ىضرلما ىدل دئاسلا وه يوبلأا طمنلا ناك امنيب يلاعلا ميلعتلا يكلاهتسلاا طمنلا امأ ةنمزم ةيحص ضارمأب ينباصلما كئلوأ و نسلا ليلحتلا حضوأ امك .ةنس ةباشلا ةحيرشلا ىدل دئاسلا ناكف اًبلاغ ثانلإا نأ كراشلما طمنلا ةعومجم عم ةنراقلماب ددعتلما يفوحتلا دودح ،2.87 :لامتحلاا ةبسن( يكلاهتسلاا طمنلا نولضفي ام ةدايز للاتعاب ينباصلما ريغ ىضرلما كلذكو )6.27-1.31 :ةقثلا نأو ،)1.03-8.09 :ةقثلا دودح ،2.90 :لامتحلاا ةبسن( نوهدلا اًنس ربكلأا ةيرمعلا ةحيرشلا نم مه اًبلاغ يوبلأا طمنلا اولضفي نم ثانلإا اًضيأو )1.01-1.05 :ةقثلا دودح ،1.03 لامتحلاا ةبسن( .)1.32-4.06 :ةقثلا دودح ،2.47 :لامتحلاا ةبسن( رارق يف ىضرلما ةكراشم طانمأ نأ ةساردلا هذه تحضوأ :ةتمالخا طانملأا هذه رابتعا نإ .ريبك لكشب ددعتتو فلتخت ةيبطلا ةكراشلما ةجرد ىلع يبطلا رارقلا يف ةكراشلما ىدم يف ىضرلما تابغر ديدتحو .ةنكملما ةيبطلا جئاتنلا لضفأ ىلع لوصحلل ةيمهلأا نم ةريبك Objectives: To determine preferences of patients regarding their involvement in the clinical decision making process and the related factors in Saudi Arabia. Methods: This cross-sectional study was conducted in a major family practice center in King Abdulaziz Medical City, Riyadh, Saudi Arabia, between March and May 2012. Multivariate multinomial regression models were fitted to identify factors associated with patients preferences. Results: The study included 236 participants. The most preferred decision-making style was shared decisionmaking )57%(, followed by paternalistic )28%(, and informed consumerism )14%(. The preference for shared clinical decision making was significantly higher among male patients and those with higher level of education, whereas paternalism was significantly higher among older patients and those with chronic health conditions, and consumerism was significantly higher in younger age groups. In multivariate multinomial regression analysis, compared with the shared group, the consumerism group were more likely to be female [adjusted odds ratio )AOR( =2.87, 95% confidence interval [CI] 1.31-6.27, p=0.008] and non-dyslipidemic )AOR=2.90, 95% CI: 1.03-8.09, p=0.04(, and the paternalism group were more likely to be older )AOR=1.03, 95% CI: 1.01-1.05, p=0.04(, and female )AOR=2.47, 95% CI: 1.32-4.06, p=0.008(. Conclusion: Preferences of patients for involvement in the clinical decision-making varied considerably. In our setting, underlying factors that influence these preferences identified in this study should be considered and tailored individually to achieve optimal treatment outcomes. Saudi Med J 2015; Vol. 36 (12): 1472-1476 doi: 10.15537/smj.2015.12.13682 From the Department of Family Medicine (AlHaqwi, AlFarhan), the Department of Pediatrics (AlRumayyan), the Department of Basic Sciences (Badri), College of Medicine, King Saud bin Abdulaziz University for Health Sciences, the Department of Family and Community Medicine (AlKhashan), Prince Sultan Military Medical City, Riyadh, the Department of Otolaryngology (AlDrees), College of Medicine, Prince Sattam bin Abdulaziz University, Al-Kharj, and the Diabetic Center (Alotaibi), Ministry of Health, Gurrayat, Kingdom of Saudi Arabia. Received 17th August 2015. Accepted 7th October 2015. Address correspondence and reprint request to: Dr. Ali I. AlHaqwi, Department of Family Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia. E-mail: [email protected] OPEN ACCESS 1472 Saudi Med J 2015; Vol. 36 )12( www.smj.org.sa 1473 www.smj.org.sa Saudi Med J 2015; Vol. 36 )12( Clinical decision making in Saudi Arabia ... AlHaqwi et al P and physicians assume different and varying roles in the medical consultation process. This could determine the extent of involvement of the patient and the physicians in the clinical decision making process and patient care management. In one extreme, the physician assumes the responsibility of the clinical decision with no or very little joint deliberation with the patient. This is known as the “paternalistic” approach.1,2 In the other extreme, the informed medical decision approach means that the clinical decision is made by patients and potential others, including family members, after obtaining all needed medical information that could enable the patient to make on appropriate decision. This is known as the “consumerism” approach to clinical decision-making.3,4 Shared decision making is probably at the center of this spectrum, in which patients and physicians exchange information, discuss the details of the medical problems, explore available treatment options, and conclude together an agreed treatment plan.5 The provision of health care that is consistent with the preferences of patients may improve the patients’ satisfaction and health outcomes.6,7 The practice of shared clinical decision-making was encouraged as it respects patients’ autonomy, values, and commitment to the agreed health plan and continuity of care.8 The relevant literature shows that most patients prefer to be offered information on their medical conditions, available options of treatment, and future plan of care.1,3,9 However, the extent of the involvement of patients in the process of decision making is variable and influenced by issues related to the patients status of their illnesses, and types of decisions under consideration.10,11 Patients of younger age, women, and with higher levels of education have been found to prefer an active role and to share this process. In addition, preferences of patients may change with time and different stages of the sickness.11,12 The complexity of this process is further compounded by the fact that patient views and attitudes towards involvement in medical decision making are influenced significantly by certain underlying cultural aspects. This necessitates a sensitive and individual approach for each patient.13 This study aims to explore preferences of patients from Saudi Arabia regarding their involvement in medical decision making, and to explore factors that may affect these preferences. Methods. This cross-sectional study was conducted in a major family practice center in King Abdulaziz Medical City, Riyadh, Saudi Arabia between March and May 2012. This family practice center provides highly accessible and comprehensive medical care to all eligible patients and their families. Most patients with acute and chronic problems receive their medical treatment in this center, and if needed will be referred for diagnostic and therapeutic services to the affiliated secondary and tertiary care services. This is a well-equipped and staffed busy health care center that serves 1200 patients daily. Adult Saudi patients presented to this center, either as walk-in, or with prior appointments, were invited to participate in this study. After the end of their visit, patients that consented to participate in the study were requested to complete a structured questionnaire designed to address the objectives of the study. The questionnaire was written in Arabic. The questionnaire. The questionnaire consisted of 3 main parts; demographic characteristics, presence and details of chronic diseases, and questions related to preferences for involvement in clinical decision making. The options for decision making were presented to patients as follows: “If you have obtained all needed information related to the available treatment options on your medical problems, who do you prefer to take the final decision on your treatment?” Patients were given many responses that were grouped into 3 options: 1( The final decision will be taken by me, or my family without involvement of the physician. 2( The final decision will be left to the physician only, and 3( The decision will be taken, after discussion and agreement, jointly by me and my physician. If the patient indicated a preference for the first option of making the decision by him/her alone, or with the help of family members and without the involvement of a physician, then this was labeled as the informed “consumerist” style of decision making. The second option indicates the “paternalistic” style. The third option was labeled “shared decision making” in which the patients prefers to involve the physician in the management process either alone, or along with other family members. To ensure content validity of the questionnaire, it was constructed by utilizing available published data.2-6,9 The content of the questionnaire was further discussed and reviewed by a group of family medicine consultants. This was followed by a pilot study to further check the validity and clarity of the questionnaire. The study proposal was reviewed and approved by the Ethics Committee of King Abdullah International Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. Disclosure. Authors have no conflict of interests, and the work was not supported or funded by any drug company.