Affiliation:
1. Department of Humanities and Social Sciences, Indian Institute of Technology New Delhi, Delhi, India
Abstract
Though many studies have linked shared decision-making with positive patient outcomes and patient satisfaction, there is less research on the practicality and feasibility of such an approach, specifically, in India. Recent findings indicate that contextual constraints of the patients and family caregivers are fused with and inevitably shape their decision-making style. This study investigates the influence of individual (paternalistic and shared decision-making style) and contextual (financial status of the patients) factors on certain cultural aspects of decision process, namely, trust in doctors, patient’s agency, emotional distress and attribution of responsibility. Data were collected using a survey questionnaire from a sample of 306 participants. Linear mixed models were used to analyse the responses. The results indicate that a shift towards shared approaches does yield qualitatively superior outcomes in terms of increased trust in doctors and patients’ agency along with reduced emotional distress. The study also emphasises the role of cultural metaphysical beliefs in attributing responsibility for treatment decisions. Further, low financial status was found to be associated with higher trust in doctors, lower patient agency, and increased emotional distress for both patients and family caregivers. The move towards shared decision-making, considering the contextual realities of patients, could be instrumental in addressing critical issues, such as prevalence of collusion, superficial role of informed consent, and high reliance on doctors’ authority or expertise.