Researchers: Orit Karnieli-Miller¹, Eddy Karnieli², Galit Neufeld Kroszynski¹

Background: Patient-Centered Care (PCC) is a common healthcare policy approach emphasizing the importance of treating patients as people and involving them in their care. Shared Decision Making (SDM) is a recommended model for practicing PCC and for involving patients in their care. However, its dissemination and implementation efforts in diabetes care globally and in Israel specifically, are limited.

Objectives: 1) To identify barriers and facilitators to the dissemination and implementation of SDM in diabetes care from the perspectives of the different stakeholders: medical staff, patients, and family members.
2) To provide recommendations to facilitate SDM in diabetes care in Israel.

Method: A qualitative, Immersion/Crystallization study. Sixty-one semi-structured interviews were conducted with the stakeholder groups. These focused on their perceptions of SDM in diabetes, and barriers and facilitators to SDM. Vertical and horizontal analysis was used to learn about each interviewee’s perception and comparing the different stakeholders’ perspectives.

Findings: Diabetes is a challenge for healthcare professionals emphasizing their "lack of control” over the patient’s adherence regarding day-to-day diabetes management. We identified two different styles in the manner in which they deal with this challenge: 1) Professionals who came to terms with this “lack of control” and emphasize patients involvement in their care using most of SDM components; (2) Professionals who experience frustration and a sense of failure and tend toward trying to (over) control the treatment decision with limited use of SDM practices.

Conclusions: The way in which professionals deal with the issue of lack of “control” can be a precursor or barrier to their engagement in SDM.

Recommendations: Providing tools to reflect and deal with professionals’ sense of lack of “control,” can help them learn why and how communicating in a PCC manner and implementing patient engagement through SDM, would support patients' management of their diabetes toward their treatment goals.

Research end date: 03/2020