Discussion
SDM comprises three main elements: the exchange of information (personal and medical) between the patient and the doctor, the discussion on diagnostic and treatment options and the building of consensus20, 21 .
In our study, we have identified concerns among patients about the SDM process related to the enough information delivery to take a decision about patient preferences. It was reported that the doctor has not always rated adequately or met their informational needs. This research showed relatively low scores to SDM-Q-9 items 5 (patients’ information), 6 (patients’ preference), 7 (weighing options), and 8 (shared decision). This means that doctors should actively invite patients to share their goals, expectations, and concerns to prevent misdiagnosis of patient preferences 22, and that treatment decisions are currently limited to informing the patient, as found in previous studies23. Our study showed that identifying and considering patient preferences is not common in treatment yet and that women’s responses are lower than men’s responses. Most patients indicated that their doctor had not informed them about all strabismus management options and that they would prefer to receive more information about the treatment (3.36 points). As a consequence Tamaris et al. raised the question of whether patients can really participate if they do not know all the options.24. Our study showed that some patients believe that their doctors had not evaluated the level of information that they wanted to receive. In contrast, the doctor found that the information provided to patients was sufficient, and that the consultation process and joint decision-making process were satisfactory (overall score SDM-Q-Doc 4.0). This raises a question (concern) about the possible lack of knowledge of health workers about what is actually a general decision-making process and how it should be carried out.
Charles CA et al. (2003) have shown that doctors do not always give recommendations on which treatment option they consider to be preferable.25 The other authors have found that when developing a recommendation, many doctors do not disclose their personal opinions about optimal treatment, but, instead, focus on providing information about the risks and benefits of each option, with the patient choosing. 26-28.
One of the main components of SDM is determining patient values and preferences for different treatment options 29,30.. Anyway, not all the doctors are ready to discuss patients’ values and needs; otherwise, some feel like their clinical experience will be compromised if the patient disagrees with their recommendations. Therefore, this choice sometimes may not be the best one for the patient, after considering his values and needs.22. If patients disagree with the treatment recommendations, this may be due to a mismatch between their preferences and the perception of these preferences by doctors. Benbassat J et al. (1998) revealed that doctors’ conclusions about patient values and preferences are often inaccurate, even for doctors with more clinical experience and a longer relationship between doctor and patient 31. It is not astonishing, that Tamarisa et al. concluded that many patients got serious problems in SDM 24. The relatively low scores given by patients in our study regarding the shared decision process could be because there was no clear equipoise toward one of the existing treatment methods or there was time absence. The fact that SDM is a time consuming process has also been mentioned by other authors29. Some patients need more time to assimilate and become aware of the information received from the doctor. Our study revealed a mean of 3.2 consultations required before a shared “patient- doctor” decision was reached. Young patients required fewer consultations compared to adults, which could be explained by their desire to regain the phisical appearance, to imorove the quality of life as soon as possible. Elder patients needed more time to decide. Furthermore, our results suggest that the higher the SDM score, which means higher patient involvement in their healthcare process, the higher is their satisfaction with the provided care. This fact demonstrates once more that by providing recommendations and performing the treatment in concordance with a patient’s preferences, the healthcare and research agenda may become truly patient centered.
This study has some limits. Firstly, the small number of the participants limits generalization to all patients and physicians involved in strabismus nursing. Only one physician was involved in the study. A more representative sample of doctors, or a sample of doctors and patients from multiple regions, may produce different results than the one we received.