Factors Influencing Shared Decision-Making in Hong Kong Specialist Outpatients: A Mixed-Methods Study

Abstract Background Actively involving patients in shared decision-making (SDM) is vital for patient-centered care and better health outcomes. However, the implementation of SDM in routine medical care remains problematic. This study examined factors influencing SDM participation among specialist outpatients in Hong Kong. Methods A two-phase study was conducted. Phase I involved in-depth interviews (June-July 2024) based on Social Cognitive Theory, exploring factors affecting SDM participation. Phase II was a cross-sectional survey (September-December 2024) informed by Phase I findings and existing literature, collecting data on patient demographics, SDM experiences, and influencing factors. Multivariable regression analyses identified factors affecting SDM. Results In Phase I, interviews with 30 patients (14 males, 16 females; 19 below 60 years, 11 aged 60+) revealed key barriers and facilitators, including personal factors (i.e., patient health literacy, demographics, and health status), behavioural factors (i.e., patient trust in doctors, and interaction with doctors), and environmental factors (i.e., quality of doctor care, consultation time). In Phase II, 600 patients (45.5% males, 54.5% females; 29.8% aged 18-60, 70.2% over 60) completed the survey. Regression analyses revealed that younger individuals (aOR = 0.72 [95%CI:0.59-0.86], p < .001), those in poorer health (aOR = 0.72 [95%CI:0.43-0.87], p = .007), and those who live with families (aOR = 0.46 [95%CI:0.24-0.84], p = .01), and those who perceived the quality of care to be high (aOR = 1.72 [95%CI:1.11-2.70], p = .02) were significantly more likely to engage in SDM. Conclusions This mixed-methods study identified a range of personal, behavioural, and environmental factors that influence patient involvement in SDM. Interventions targeting these factors are crucial for advancing SDM and achieving patient-centered care in specialist outpatient settings. Key messages • Personal, behavioural, and environmental factors shape outpatient involvement in SDM. • Enhancing SDM requires attention to patient characteristics, doctor-patient interaction, and care quality in specialist clinics.