Positive Psychology Insights on the Effects of Spirituality on Shared Decision-Making in Patients with Chronic Heart Failure: The Chain-Mediated Effects of Benefit-Finding and Decision Self-Efficacy

<b>Background</b>: As the terminal stage of cardiovascular disease, heart failure (HF) has garnered significant attention due to its recurrent nature, high mortality rates, and substantial medical burden. Shared decision-making (SDM) is an innovative strategy to improve medication adherence. From positive psychology insights, the effects on spirituality, benefit-finding (BF), decision self-efficacy, and patient engagement in SDM remain unexplored. <b>Methods</b>: This quantitative cross-sectional study was conducted from January 2023 to September 2024 at a hospital in Jiangsu. Data on general information, spirituality, BF, decision self-efficacy, and SDM were collected from 387 patients with chronic heart failure. <b>Results</b>: Spirituality was significantly associated with SDM (β = 0.8839, <i>p</i> < 0.001). BF played a mediating role in the relationship between spirituality and SDM (β = 0.2020, 95% CI: 0.0058-0.0261), accounting for 22.9% of the total effect. Decision self-efficacy was identified as a mediator in this relationship (β = 0.2636, 95% CI: 0.0120-0.0284), accounting for 29.8%. In addition, both BF and decision self-efficacy exhibited a chain mediation effect on the association between spirituality and SDM (β = 0.1451, 95% CI: 0.0061-0.0162), and the total indirect effect accounted for 69.1%. <b>Conclusions</b>: This study is the first to demonstrate that spirituality has significant direct and indirect effects on SDM, and it also reveals the underlying psychological mechanisms. Spiritual support services, BF intervention, and enhancing patients' decision self-efficacy can promote their participation in SDM. These findings highlight the role of positive psychology in promoting SDM, showing potential contribution to promoting medication adherence in HF patients.