Shared Decision-making between health care providers and patients at a Tertiary Hospital Diabetic Clinic in Tanzania

Abstract

BackgroundPatients’ participation in decision making regarding their treatment is defined in ethical, legal and human rights standards in the provision of care that concerns health providers and the entire community.ObjectiveTo assess practices and challenges of diabetic patients and healthcare providers’ participation in shared decision making at Muhimbili National Hospital in Dar es Salaam.MethodsThis study employed a phenomenological study design using in-depth interview technique. Study participants were diabetic patients visiting the clinic and healthcare providers working at Muhimbili national hospital. Data was collected using the semi-structured interview guide with open-ended questions using an audio digital recorder. Content analysis method was used during analysis whereby categories were reached through the process of coding with assistance by Nvivo 12 software.ResultsThe study found that most participants participate in shared decision making. Few patients indicated partial participation in shared decision making. Decision aids were found important for execution of shared decision making but they are scarce. Likewise, the study found that beliefs and values, time and education level are barriers to shared decision making.ConclusionAlthough this study indicated that shared decision making is practiced at Muhimbili national hospital, further search in this area is needed to be done in other hospitals.

An Insight into Patients’ Perspectives on their Participation in Medical Decision Making in Diabetes Mellitus Care in Malawi.

“…While the patient -provider power imbalance seems inevitable in clinical encounters, it is a reported drawback for lack of patients' participation (9,10). Due to socio-political predispositions, patients in this study perceive that providers are a superior and unchallenged authority; and that their role should be a subservient, grateful recipient of care.…”

“…However, it was found that the passivity was related to fear of their providers reaction if they engaged in asking questions. (14) The stated experience highlights a failed therapeutic patient -provider relational ambience where patients do not feel safe enough to contribute or question about their care (10,15).…”

“…As a process of care, patient participation in decision making enhances positive experiences of care (2,9). Particulary in the chronic disease journey, participation assists in treatment goal setting facilitating medication adherence, and lifestyle modi cation through enhancement of patient self-e cacy for self -care ( 2,10,11).…”

“…While variations in the extent to which a patient wishes to participate in care across and in between encounters has been reported in literature, most patients are reported to prefer some level of participation (7)(8)(9)(10). Elwyin et al adds that there is generally very minimal objections about patient involvement amongst different patients groups (11).…”

“…While at institutional level, it may include factors such as interactional time constraints, and at systems level, contextual issues such as an authoritarian socio-political context (9). For example, patients with authoritarian sociocultural backgrounds have been reported to have lower the likelihood of initiating engagement with a medical authority or to participate in their own care (9,10).…”