Shared decision-making revisited: The nexus of learning, culture, and behavior change

In healthcare, 'shared decision making' (SDM) refers to when both the patient and clinician collaborate to determine the best course of care or treatment. Despite its growing importance, SDM isn't consistently practiced. Doctors play a key role in its application, leading this thesis to explore how to effectively teach SDM to young doctors and examine the factors influencing its adoption in practice, such as doctor culture, personal beliefs, cognitive processes, and contextual factors. The research reveals that most SDM training programs in healthcare fall short in providing effective learning experiences, lacking experiential learning and opportunities for reflective practice. Even when doctors receive patient feedback, it does not always translate into improved decision-making, often due to insufficient mentor guidance. Additionally, doctors' culture, emphasizing medical evidence and autonomy in decision-making, affects their approach to SDM. Challenges arise when care becomes complex, leading to inconsistencies between traditional practices and collaborative decision-making. Despite efforts to empower patients, doctors often still make decisions on their behalf. Effective SDM requires active doctor involvement to tailor care to each patient's unique needs, yet doctors may struggle in this regard. Initiatives to enhance SDM must recognize its complexity and leverage insights from other disciplines to support professional learning and change. The study employed various research methods, including a systematic review of SDM training initiatives, interviews with healthcare providers, patient questionnaires, and an anthropological study exploring doctor culture's impact on SDM. Research findings are qualitatively analyzed, drawing on diverse social science theories.