Perceptions of shared decision making in gastroenterology and inflammatory bowel disease: A qualitative analysis

Livnat Blum; Carlotta Micaela Jarach; Moriah E Ellen

doi:10.1016/j.pec.2023.107877

Perceptions of shared decision making in gastroenterology and inflammatory bowel disease: A qualitative analysis

Patient Educ Couns. 2023 Oct:115:107877. doi: 10.1016/j.pec.2023.107877. Epub 2023 Jun 28.

Authors

Livnat Blum¹, Carlotta Micaela Jarach², Moriah E Ellen³

Affiliations

¹ Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel. Electronic address: livnatblum@gmail.com.
² Laboratory of Lifestyle Research, Department of Medical Epidemiology, Mario Negri Institute of Pharmacological Research, IRCCS, Italy. Electronic address: carlotta.jarach@marionegri.it.
³ Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel; Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Canada; Israel Implementation Science and Policy Engagement Centre, Ben-Gurion University of the Negev, Israel. Electronic address: ellenmo@bgu.ac.il.

PMID: 37437510
DOI: 10.1016/j.pec.2023.107877

Abstract

Objective: Shared decision-making (SDM) is the partnership and discussion between clinicians and patients to make an appropriate decision based on scientific evidence and patient preferences. Many benefits are associated with SDM; however, little is known about its awareness or use by inflammatory bowel disease (IBD) clinicians in gastroenterology departments across Israel. This study aims to identify barriers and facilitators in implementing SDM as standard practice to achieve optimal disease management and personalized care for patients with IBD.

Methods: Sixteen semi-structured interviews were conducted with IBD clinicians across Israel to identify the barriers and facilitators for SDM use. An interview guide was developed, based on the systematic approach of the Theoretical Domain Framework (TDF). Interview transcripts were coded into theoretical domains to identify factors that may impact SDM.

Results: Sixteen gastroenterologists from nine different hospitals were interviewed. Common TDF domains that presented as barriers were: knowledge, skills, social/professional role and identity, environmental context and resources, and reinforcement. Most participants had never heard the precise term "shared decision making" and lacked formal training on SDM.

Conclusion: This study identified key barriers and facilitators to SDM in IBD clinics across Israel. Main barriers of SDM include limited or nonexistent training; clinicians were unaware of SDM guidelines or techniques. The main facilitators of SDM were clinicians' social and professional role and identity and their beliefs about the influence of IBD and/or CD.

Practice implications: These influencing factors and TDF domains identified provide a basis for developing future interventions to improve the implementation of SDM within IBD management.

Keywords: Clinical decision-making; Clinician perspective; Clinician's role; Gastroenterology; Inflammatory bowel disease; Patient-centered care; Shared decision-making.