title: Shared decision-making: the perspectives of young adults with type 1 diabetes mellitus.
abstract: BACKGROUND
  Shared decision-making (SDM) is at the core of patient-centered care. We examined whether young adults with type 1 diabetes perceived the clinician groups they consulted as practicing SDM.
  
  
  METHODS
  In a web-based survey, 150 Australians aged 18-35 years and with type 1 diabetes rated seven aspects of SDM in their interactions with endocrinologists, diabetes educators, dieticians, and general practitioners. Additionally, 33 participants in seven focus groups discussed these aspects of SDM.
  
  
  RESULTS
  Of the 150 respondents, 90% consulted endocrinologists, 60% diabetes educators, 33% dieticians, and 37% general practitioners. The majority of participants rated all professions as oriented toward all aspects of SDM, but there were professional differences. These ranged from 94.4% to 82.2% for "My clinician enquires about how I manage my diabetes"; 93.4% to 82.2% for "My clinician listens to my opinion about my diabetes management"; 89.9% to 74.1% for "My clinician is supportive of my diabetes management"; 93.2% to 66.1% for "My clinician suggests ways in which I can improve my self-management"; 96.6% to 85.7% for "The advice of my clinician can be understood"; 98.9% to 82.2% for "The advice of my clinician can be trusted"; and 86.5% to 67.9% for "The advice of my clinician is consistent with other members of the diabetes team". Diabetes educators received the highest ratings on all aspects of SDM. The mean weighted average of agreement to SDM for all consultations was 84.3%. Focus group participants reported actively seeking clinicians who practiced SDM. A lack of SDM was frequently cited as a reason for discontinuing consultation. The dominant three themes in focus group discussions were whether clinicians acknowledged patients' expertise, encouraged patients' autonomy, and provided advice that patients could utilize to improve self-management.
  
  
  CONCLUSIONS
  The majority of clinicians engaged in SDM. Young adults with type 1 diabetes prefer such clinicians. They may fail to take up recommended health services when clinicians do not practice this component of patient-centered care. Such findings have implications for patient safety, improved health outcomes, and enhanced health service delivery.
authors.affiliation: Centre for Clinical Governance Research in Health, Australian Institute of Health Innovation, University of New South Wales.
authors.forename: Janice
authors.initials: J
authors.lastname: Wiley
authors.affiliation: Centre for Clinical Governance Research in Health, Australian Institute of Health Innovation, University of New South Wales.
authors.forename: Mary
authors.initials: M
authors.lastname: Westbrook
authors.affiliation: Diabetes and Obesity Program, Garvan Institute of Medical Research ; Department of Endocrinology, St Vincent's Hospital, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Jerry R
authors.initials: JR
authors.lastname: Greenfield
authors.affiliation: Department of Clinical Pharmacology, St Vincent's Hospital, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Richard O
authors.initials: RO
authors.lastname: Day
authors.affiliation: Centre for Clinical Governance Research in Health, Australian Institute of Health Innovation, University of New South Wales.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Braithwaite
keywords: glycemic control; health service delivery; patient autonomy; patient perspective; patient-centered care; shared decision-making; type 1 diabetes; young adults
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