title: Physicians' perceptions of shared decision-making behaviours: a qualitative study demonstrating the continued chasm between aspirations and clinical practice.
abstract: BACKGROUND
  Shared Decision Making (SDM) is a process of engaging patients in health decisions that involve multiple medically appropriate treatment options. Despite growing public and policy support for patient engagement in health decisions, SDM is not widely practiced in clinical settings.
  
  
  OBJECTIVE
  The purpose of our study was to explore clinicians' attitudes, beliefs and perceived social norms about engaging in SDM behaviours.
  
  
  METHODS
  Semi-structured qualitative interviews were conducted with physicians in five practice areas.
  
  
  METHODS
  This study was conducted at an academic medical centre in St. Louis, MO. The final sample included 20 physicians: five surgeons, five OB/GYNs, four medical oncologists, five internists and one emergency medicine physician.
  
  
  RESULTS
  Clinicians described a number of beliefs and cultural- and system-level obstacles to the widespread implementation of SDM, such as how to engage in discussions of cost, uncertainty and clinical equipoise and how to engage patients across various socioeconomic backgrounds.
  
  
  CONCLUSIONS
  Although a large number of participants expressed general support for incorporating SDM into practice, most held fundamentally inconsistent beliefs about practicing specific SDM behaviours. More extensive training of physicians at all levels (pre- and post-licensure) can help increase clinicians' confidence in SDM skills. Developing methods of integrating SDM into the institutional framework of hospitals and training programmes could also increase clinicians' motivation to practice SDM and work to change the culture of medicine such that SDM behaviours are supported.
authors.affiliation: Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Zeuner
authors.affiliation: Patient Care Program, Gordon and Betty Moore Foundation, Palo Alto, CA, USA.|Department of Medicine, University of California, Los Angeles, CA, USA.|Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA.
authors.forename: Dominick L
authors.initials: DL
authors.lastname: Frosch
authors.affiliation: Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
authors.forename: Marie D
authors.initials: MD
authors.lastname: Kuzemchak
authors.affiliation: Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Politi
mesh_terms: D001291:Attitude of Health Personnel; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D010358:Patient Participation / Q000379:methods; D018802:Patient-Centered Care; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D036301:Qualitative Research
keywords: patient preferences; patient-centred care; patient-clinician communication; shared decision making