The perspectives of iranian physicians and patients towards patient decision aids: a qualitative study

Abstract

BackgroundPatient preference is one of the main components of clinical decision making, therefore leading to the development of patient decision aids. The goal of this study was to describe physicians’ and patients’ viewpoints on the barriers and limitations of using patient decision aids in Iran, their proposed solutions, and, the benefits of using these tools.MethodsThis qualitative study was conducted in 2011 in Iran by holding in-depth interviews with 14 physicians and 8 arthritis patient. Interviewees were selected through purposeful and maximum variation sampling. As an example, a patient decision aid on the treatment of knee arthritis was developed upon literature reviews and gathering expert opinion, and was presented at the time of interview. Thematic analysis was conducted to analyze the data by using the OpenCode software.ResultsThe results were summarized into three categories and ten codes. The extracted categories were the perceived benefits of using the tools, as well as the patient-related and physician-related barriers in using decision aids. The following barriers in using patient decision aids were identified in this study: lack of patients and physicians’ trainings in shared decision making, lack of specialist per capita, low treatment tariffs and lack of an exact evaluation system for patient participation in decision making.ConclusionsNo doubt these barriers demand the health authorities’ special attention. Hence, despite patients and physicians’ inclination toward using patient decision aids, these problems have hindered the practical usage of these tools in Iran - as a developing country.

The attitude of physicians toward the use of patient decision aids in iran as a developing country

“…[ 23 ] The related qualitative study suggests that patients’ tendency to become involved in decision-making depends on the kind and intensity of their disease as well as their education level. [ 15 ] Therefore, neglecting this fact can have adverse effects on patient satisfaction and well-being, and can decrease fruitfulness of the treatment method. [ 24 ]…”

“…This is perhaps because of systemic problems such as improper distribution of human force, shortage of time, awareness and training deficits, and shortage of theoretical and practical clinical trainings in the internship period. [ 15 ] Hence, it is particularly important to assess service models and plan on the employment of proper strategies for increasing the awareness of physicians and managing the available bedside resources. [ 32 33 34 ]…”

“…[ 16 ] In Iran, as a developing country, the only research conducted on the use of PDAs is the qualitative study, which analyzes the viewpoints of physicians and patients on the challenges and obstacles to the use of such tools. [ 15 ] The above-mentioned substantial and important challenges, which patients and physicians are faced with in using such tools were reported as the findings of this study. However, in addition to this information, quantification of physicians’ opinions on these challenges is required to help prioritize the problems and present solutions in planning on using the tools.…”

“…[ 1 14 ] Although numerous advantages have been listed for joint decisions made with the mutual participation of physicians and patients, there are challenges (such as shortage of medical training for joint decision-making, physicians’ time limits, or patient's unwillingness to cooperate) to this end. [ 15 ] The tools are designed and used in bedside in the developed countries such as the United States, Canada, and England. However, among developing countries, Saudi Arabia is the only country to design and employ such tools.…”

Call for shared decision making in Iran; Future directions

“…Increasing knowledge and awareness among patients: lack of knowledge and awareness among patients, 13 including lack of awareness about their rights, is a barrier in implementing SDM in Iran. 12 Therefore development of strategies to increase general public' awareness and knowledge seems necessary.…”