The physiatrist’s attitude towards Shared Decision-Making a further analysis among physiatrists on the role of shared decision-making in rehabilitation healthcare



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3.5Barriers and facilitators for shared decision making


Physiatrists’ responses to the question “To what extend do you experience the following as difficulties during the treatment decision-making process?” are presented in Table 5. Factors seen as a barrier by more than 50% of the physiatrists include: the patients received conflicting recommendations from various specialists, the patient has difficulty accepting the disease, the patient’s family overrides the decision-making process and the patient had misconceptions about the disease or treatment. Time was not seen as one of the strongest barriers, but still 42% of the respondents indicated it to be a barrier for the decision-making process.

Nearly all physiatrists (98%) perceived trust as a facilitator for the decision-making process. Ninety percent indicated that a patient’s willingness to participate in the decision-making also facilitates the process. Table 6 provides respondents’ mean score for each item.



Table 5. Perceived barriers to treatment decision-making among physiatrists.

Factors

Mean (SD)

Yes (%)a

System







I have insufficient time to spend with the patient

2.31 (0.89)

43 (42.2)

The patient has received conflicting recommendations from various specialists

2.90 (0.82)

73 (71.6)

Physiatrist






I have insufficient information to make a decision about treatment at the first consultation

2.25 (0.85)

32 (31.4)

There are cultural differences between the patient and me

2.43 (0.79)

42 (41.6)

I experience difficulty knowing how to frame the treatment options for the patient

1.51 (0.72)

9 (9.0)

Patient







The patient does not understand the information I have given

2.59 (0.79)

45 (44.1)

The patient does not want to participate in treatment decision-making as much as I would like him/her to

2.32 (0.73)

42 (41.6)

The patient wants to participate more in deciding on her treatment than I would like him/her to

1.85 (0.73)

16 (15.8)

The patient is indecisive

2.39 (0.79)

41 (40.2)

The patient requests a treatment not known to be beneficial

2.44 (0.88)

48 (47.5)

The patient refuses a treatment that may benefit him/her

2.27 (0.88)

36 (35.6)

The patient has difficulty accepting his/her disease

2.80 (0.76)

66 (65.3)

The patient is too anxious to listen to what you have to say

2.40 (0.86)

43 (42.6)

The patient brings too much information to discuss

2.23 (0.81)

33 (32.7)

The patient has other health problems

2.11 (0.77)

30 (29.7)

The patient wants to make a decision before receiving the information from me

2.11 (0.85)

28 (27.7)



The patient’s family overrides the decision-making process

2.52 (0.86)

51 (50.5)

The patient has misconceptions about the disease or treatment

2.73 (0.76)

61 (60.4)

The patient comes expecting a certain treatment rather than a consultation

2.31 (0.90)

37 (36.6)

Note. Percentages are based on valid cases only. a A factor is considered to be seen as a barrier when a score of 3 or 4 on a Likert scale running from 1 (never) till 5 (always) is ticked.

Table 6. Perceived facilitators to treatment decision-making among physiatrists.



Factors

Mean (SD)

Yes (%)

The patient has someone with them at the consultation

3.32 (0.68)

92 (92.0)

The patient talks to someone else with the same condition

2.92 (0.71)

74 (74.4)

The patient has emotional support from family or others

3.44 (0.64)

96 (94.1)

The patient is emotionally ready for decision-making

3.24 (0.89)

83 (81.4)

The patient trusts me

3.78 (0.46)

100 (98.0)

Providing written information to the patient

3.04 (0.73)

81 (79.4)

The patient has contact with a support group

2.70 (0.79)

60 (59.4)

The patient seeks a second medical opinion

2.46 (0.74)

47 (47.0)

The patient wants to participate in making the treatment decision

3.27 (0.69)

92 (90.2)

The patient is prepared (knowledgeable about the disease and treatment) before the consultation

3.49 (0.66)

95 (93.1)

The patient has friends who work in the health care system

2.29 (0.75)

39 (38.6)

Note. Percentages are based on valid cases only. aA factor is considered to be seen as a facilitator when a score of 3 or 4 on a Likert scale running from 1 (never) till 5 (always) is ticked.


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