Preferences for shared medical decision-making: Cross-cultural perspectives

Abstract

The goal of this thesis project was to investigate cross-cultural differences in preferences for shared medical decision-making (SDM) by studying adults from the UK and Saudi Arabia. The aim of Study 1 was to gauge preferences for SDM in nonclinical samples from the UK and Saudi Arabia. Results show that there were indeed differences in SDM between Saudi and UK participants. Saudi participants tended to prefer stronger involvement from their doctor, whereas UK participants preferred to make choices themselves. The aim of Study 2 was to investigate in how far Saudi patients with Type 1 diabetes would be interested to be involved in a medical decision. The results of this qualitative study showed that, in general, physicians were reported to often have poor communication skills, which makes patients feel uncomfortable. Participants reported that their physician gave them medication without any discussion over the reasoning behind the prescription provided. Study 3 investigated parents’ preferences regarding their involvement in medical decisions when making decisions for themselves or their child, to record parents’ emotional reaction to shared medical decision-making, and to identify cultural differences on these topics in parents from Saudi Arabia and the UK. The results showed that parents were more likely to take an active role in the decision-making process when making the decision for themselves rather than their child. Decision confidence was higher in the non-informed choice condition. Emotional reaction and decision confidence were higher in the informed choice condition. A number of important recommendations for policy and practice that aim to increase shared decision-making and highlight the importance of culture. While European health-care professionals are increasingly encouraged to involve patients in decisions about their care, this study indicates that preferences for such shared medical decision making vary by culture and the recipient of the decision. This should be taken into account when health care professional involves patients in medical decisions.