Do socio-economically disadvantaged patients prefer shared decision-making?

Abstract

Background: Shared decision-making is the process where patients and clinicians work together to make healthcare choices. When given a choice, most patients want to participate in decision-making about their treatment. There is a perception amongst clinicians that socio-economically disadvantaged patients do not want to participate in shared decision-making. This study investigated if patients visiting the Family Medicine Outpatient Clinic at Kalafong Hospital in Gauteng, South Africa, would prefer shared decision-making.Methods: Cross-sectional survey was performed using the Control Preference Scale. Patients visiting the Family Medicine Outpatient Clinic at Kalafong Hospital were purposively selected (n = 150) between February 2016 and May 2016.Results: The patients had a median age of 52 years and 53% did not finish grade 12 at school. Their median income was R3200.00 (South African Rand [ZAR]; less than $200.00) per month. Nearly half (46%) of the patients surveyed had an active preference for shared decision-making during a consultation. No demographic or disease factors had a statistically significant association with this preference.Conclusion: The perception that socio-economically disadvantaged patients do not want to actively participate in shared decision-making is incorrect according to this study. As it is not possible to predict which patients prefer an active approach to shared decision-making, it is recommended that clinicians should enquire whether they would prefer shared decision during consultations. Clinicians should also be equipped to practice this technique and an environment needs to be created that facilitates the process.

Southern African HIV Clinicians Society gender-affirming healthcare guideline for South Africa

“…11 Even in a supportive and affirming environment, there is often an unequal power relationship between the client and the healthcare provider. 27 This can be distressing to the client and have a negative impact on their care. 28 The client and healthcare provider should be collaborative partners in decisionmaking.…”

Urologists’ and general practitioners’ knowledge, beliefs and practice relevant for opportunistic prostate cancer screening: a PRISMA-compliant systematic review

“…Healthcare providers play a crucial role in influencing PCa screening uptake among men, providing them with essential information on related risks, potential benefits and uncertainties (10). However, discrepancies in the approach to PSA testing and adherence to PCa screening guidelines are reported between general practitioners (GPs) and urologists.…”

Knowledge, attitude and practice on screening and early diagnosis of prostate cancer of primary health care providers in the Free State

“…19 Healthcare providers support users to make healthcare choices through shared decision-making (SDM). 20 Guidelines of the American Cancer Society highlighted the following as vital information needed for men to make screening decisions: risks, potential benefits and uncertainties regarding PCa screening. 21 Ng and Lee 22 highlighted six steps in the practice of SDM: (1) identify the decision, (2) list the available options, (3) discuss the pros and cons of each option, (4) elicit patient values, (5) provide support and (6) make a decision.…”

“…More so, it has been shown that healthcare users from socio-economically disadvantaged areas prefer SDM. 20 In a European study that compared general practitioners (GPs) and urologists in their handling of PSA testing and guidelines on early detection of PCa, unlike the urologists, the GPs perceived the PSA test not to be useful. In addition, the GPs showed a less proactive approach to informing men about PSA and were less familiar with guidelines and recommendations on PSA testing.…”