[Point of view on Shared Decision Making: a territorial survey of healthcare professionals].

Abstract

Background and objectives: Shared Decision-Making (SDM) is an intuitive approach among healthcare professionals, but one that is still little formalized or taught in practice in France. In 2022, we carried out a qualitative study on the perception of the PDP concept among a multi-professional panel. Several themes emerged, notably around knowledge of the concept, its implementation in practice and the need for training. The aim of this study is to compare the results obtained in our qualitative study with a larger number of professionals, using a questionnaire.

Methods: Territorial distribution of a questionnaire to medical, paramedical and non-medical professionals and students during the second half of 2022. Quantitative variables are described in headcount proportions. Results from open-ended questions were analyzed by axial coding of verbatims, grouped into categories, themes and sub-themes.

Results: A total of 381 responses were collected from 10 professions (including 41% doctors, 17% pharmacists, 15% nurses, 8% midwives and 8% physiotherapists). Less than a third of respondents (28%) claimed to be trained in therapeutic patient education (TPE). Only 6% of respondents claim to be fully familiar with PDP, while 53% are unfamiliar with the concept. When asked to define PDP, the answer was appropriate in 33% of cases. The majority (81%) of respondents would like to have specific training, and 84% believe there is a link between PDP and ETP. As for the limitations of the concept, 75% of respondents cited the urgency of decision-making, 72% the lack of time, 49% organizational difficulties and lack of knowledge of the concept, and 42% lack of knowledge of the available support tools. Among the levers mentioned by respondents were: strengthening the therapeutic alliance (67%), patient demand (60%), inter-professional support (56%), team motivation (53%) and improving the patient pathway (44%). From the 130 free responses on needs for implementing PDP, 6 themes emerged: needs oriented towards professionals and towards patients, deployment of material resources, adaptation to certain specialties, institutional responsibility and difficulty in finding downstream solutions.

Conclusion: The construction of this questionnaire from the qualitative study allows us to continue our reflection. Implementation of the concept in practice still seems to be in the minority. The limitations and levers identified in the qualitative analysis are confirmed. The development of specific and adapted training seems necessary and desirable for the implementation of the PDP process, even among people trained in ETP.