Factors influencing diabetic patients’ participation in shared decision making at Muhimbili National Hospital

Abstract

ABSTRACT BACKGROUND Patients‟ participation in shared decision making (SDM) 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. SDM is accepted worldwide as it involves patients‟ rights to informed consent for medical intervention so as to avoid medical paternalism. AIM: To explore the factors that influence diabetic patients‟ participation in shared decision making at Muhimbili National Hospital (MNH) in Dar es Salaam. MATERIALS AND METHODS: This study employed a phenomenological study design using in-depth interview (IDI) data collection technique. Data collection was done between April and May of 2019 whereby 4 IDIs and 7 IDIs were conducted to healthcare providers and patients respectively. Study participants were patients with diabetes visiting and receiving care at the clinic and healthcare providers working at Muhimbili national hospital. Content analysis method was used during analysis whereby categories were reached through the process of coding with assistance by Nvivo 12 software. RESULTS: The study found that healthcare providers (HCPs) related factors including preference, institution support, time and HCP-patient relationship influence shared decision making (SDM). Patients‟ related factors including patients‟ preference for SDM, patients‟ literacy and HCP-patient relationship influence SDM. Beliefs and values are socio-cultural factors found to influence SDM. Also, the study found that decision aids are need for SDM execution. Conclusion: The study revealed that shared decision making (SDM) is a desirable model. Decision aids are important for execution of SDM. Further search is needed to assess how the involvement of relatives in SDM does not interfere with patients‟ autonomy.