From paternalism to partnership: A patient-centred view of shared decision-making in primary health care

Abstract

Background: Shared decision-making (SDM) has been advocated in the past decade for patient-centredness and autonomy. Research in primary health care (PHC) within South Africa lacks information about the uptake of SDM.
Aim: This study aimed to determine whether SDM occurred in PHC and the barriers, facilitators and sociodemographic factors that affect its uptake in the South African PHC setting.
Setting: The Alexandra Community Healthcare Centre (CHC) and Chiawelo CHC are facilities that serve the communities of Alexandra and Chiawelo, respectively.
Methods: The study was an analytical cross-sectional survey with a sample size of 391 participants conducted at two CHCs in the Johannesburg Metro district. A modified SDM Q-9 tool was used to determine if SDM occurred. This was followed by two more questionnaires that assessed patients’ preferred decision-making method and their perception of the barriers and facilitators of SDM. Analytical statistics, Pearson Chi² testing and univariate and multivariate regression were used for data analysis.
Results: Eighty-five per cent of respondents reported that SDM did not occur during their last consultation with a healthcare worker. The two most preferred consultation models were the SDM model (37%) and the paternalistic model (36%). Participants who completed secondary education (odds ratio [OR] = 2.82, 95% confidence interval [CI]: 1.10–7.23, p-value: 0.031) and tertiary education (OR = 6.28, 95% CI: 1.83–21.61, p-value: 0.004) were more likely to engage in SDM.
Conclusion: More than a third of patients wanted to be involved in SDM, but it was not routinely practised during consultations. Patients with higher levels of education reported greater SDM. Healthcare workers must be more receptive and invite open dialogue to encourage SDM.
Contribution: The information from this article can be used to strengthen undergraduate and postgraduate training around SDM, improve patient satisfaction and uptake of care.