Patients as active partners in decision-making: A qualitative exploration of the perspectives of people with T2D and their clinicians in a diabetes centre in Saudi Arabia

Evidence-based practice (EBP) and Shared decision-making (SDM) are changing the nature of healthcare decisions. Evidence-based practice is a systematic approach of critical importance to medical practice intended to optimise decision-making by emphasising the value and use of evidence from scientific resources. Shared decision-making involves treating patients as partners, involving them in decision-making, and enlisting their sense of responsibility for their care while respecting their individual values and concerns. This study is theoretically driven by a curiosity of understanding the link between evidence-based practice, shared decision-making and patient-centred communication in order to achieve optimal care. It is broadly accepted that healthcare decisions require the integration of both research evidence and individual preferences. In the last decades, SDM has been hailed as the new paradigm for the doctor-patient relationship by health institutions and policy makers. However, the meaning and practical implications of such a new paradigm have been difficult to ascertain. To date, the need to consider patients as active partners in healthcare decision-making is growing. Yet, there has been little discussion resolving the potential conflict between promoting patient participation in decision-making regarding their health and the reliant on evidenced-based options. The thesis original contribution to knowledge is to fill these knowledge gaps by exploring the views and experiences of both users and providers of diabetes care about patient involvement in decision-making. This research, using interviews, aims to develop a greater understanding of patients and doctors experience of communicating treatment and management during medical encounters, in light of the need for a more person-centred approach in decision-making to enhance quality of patient care and improve outcomes. Forty-six semi-structured interviews were conducted with doctors and patients with Type 2 Diabetes from one of the government hospitals in Eastern Province, Saudi Arabia. Data were analysed with the aid of NVivo using thematic analysis. Evidence suggests that people living with diabetes in Saudi Arabia seem to value opportunities to be involved in everyday decision-making about their care. How these opportunities are created, understood, supported and sustained in healthcare settings remains to be determined. In this study, most of the doctors reported that involving patients into decision-making was challenging because most patients did not feel they had sufficient knowledge and confidence to do so; however, many patients reported that they did want to engage in decisions about their health but did not feel actively listened to, respected, and empowered to do so. Both groups of participants identified contrasting expectations and perceptions regarding communication within the doctor-patient relationship. The findings of this study demonstrate the need for doctors to collaboratively pursue opportunities to ensure that person-centred interactions are more consistently evident in practice. The study not only adds to what is known about the benefits of patient participation, but also provides robust evidence for policy makers and practitioners arguing for the benefits of this. Keywords: Evidence-based practice, shared decision-making, type 2 diabetes, patients’ preferences and participation, self-management