Qualitative Exploration of Factors Associated with Shared Decision-making in Diabetes Management: a Health Care Provider's Perspective

Objective: Internationally, patient-doctor interaction has shifted from the paternalist model to the shared decision-making (SDM) model, which is an essential part of effective management of chronic illnesses, especially diabetes. It is a relatively new concept in Pakistan, and data about healthcare providers' perspectives are lacking. The aim was to explore significant facilitators and barriers to effective SDM as perceived by endocrinologists.

Design: A qualitative research using in-depth interviews based on grounded theory was done. It was written in line with the Consolidated Criteria for Reporting Qualitative Research checklist.

Setting: The interviews were conducted at the workplace of the endocrinologist between April and July 2019.

Participants: Prominent endocrinologists of Pakistan residing in Lahore were approached for in-depth interviews. The transcripts were analyzed simultaneously, and theme saturation was achieved in 11 interviews.

Main Outcome Measures: Thematic analysis of data done using grounded theory.

Results: Four major and two minor themes were identified. The most cited barriers to effective SDM from the doctors' side were the shortage of time during consultations and the absence of formal training of clinicians in communication skills. However, the patients' hesitation in questioning the doctor, perceiving him as a paternalist 'messiah' in society and lack of education limits their ability to understand and comprehend treatment options.

Conclusion: There are many barriers perceived by providers as well as clients/patients by effectively using SDM. Local cultural context is influencing a lot.