Shared decision-making among non-physician healthcare professionals: Enhancing patient involvement in women's reproductive health in community healthcare settings

OBJECTIVE

Shared decision-making (SDM) is an important approach to patient-centered care in women's reproductive healthcare. This study explored SDM experiences and perceptions among non-physician healthcare professionals.

METHODS

We completed 20 key-informant interviews with non-physician healthcare professionals (i.e., NP, RN, CNM, doula, pharmacist, chiropractor) living in Indiana (September 2019-May 2020) who provided community-based women's reproductive healthcare. Interviews were audio-recorded, transcribed, and analyzed using an expanded grounded theory framework. Constant comparative analysis identified emergent themes.

RESULTS

Professionals noted community-based healthcare required contextualized decision-making approaches. Results identified listening, decisional ownership, and engagement strategies that enhanced SDM involvement. Findings suggested outcome-oriented SDM concepts, including decisional ownership and investigative listening to enhance SDM. Providers redefined 'challenging' patients as engaged in their healthcare and discussed ways SDM improved healthcare experience beyond one visit.

CONCLUSION

Findings offered insight into actionable and practical strategies for enhancing SDM in community-based women's reproductive healthcare. The findings offer strategies to improve SDM by addressing barriers and facilitators among professionals. This extends SDM beyond the patient-physician dyad and supports broader application of SDM.

PRACTICE IMPLICATIONS

Incorporating professionals' experiences into SDM concepts can enhance SDM in community-based women's healthcare practice, offering opportunities to support a culture of SDM across settings.

[Adherence to prenatal care in the north of Argentina from a social interface perspective]

Adherence to prenatal care is fundamental for diminishing maternal mortality. Usually, adherence is considered in terms of assisted women's characteristics or the specificities of the health systems and its professionals. Adherence is addressed here as the emergence of the articulation between the rationales and the life realities of physicians and pregnant women. Aiming to understand the adherence to prenatal care, a multiple case study was conducted in the North of Argentina. A total of 47 interviews of pregnant women or women that had been given birth in the last years and to agents of the health system were conducted. The content of the interviews was coded with the support of Atlas Ti software. The research identified two types or interaction between physicians and patients. The first one is based on physicians' representation of assisted women as being ignorant and disinterested, which leads professionals to insist on their recommendations without taking into account problems faced by women. The second part of conceptions is supported in the representation of women as obedient and responsible, which enables a better dialogue between physicians and patients, albeit without the knowledge of a clear interest of the life context of the women being known.