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Factors associated with level of shared decision making in Malaysian primary care consultations
Yew Kong Lee1, Yee Yang Chor1, Mae-Yen Tan2
1Department of Primary Care, University of Malaya, Kuala Lumpur, Malaysia.
Objective:
To measure the level of shared decision-making (SDM) in primary care consultations in Malaysia, a multicultural, middle-income developing country.
Methods:
A cross-sectional study was conducted in an urban, public primary care clinic. Convenience sampling was used to recruit participants, and audio-recorded consultations were scored for SDM levels by two independent raters using the OPTION tool. Univariate and multivariate analysis was conducted to determine factors significantly associated with SDM levels.
Results:
199 patients and 31 doctors participated. Mean consultation time was 14.3 min (+ SD 5.75). Patients' age ranged from 18 to 87 years (median age of 57.5 years). 52.8 % of patients were female, with three main ethnicities (Malay, Chinese, Indian). The mean OPTION score was found to be 7.8 (+ SD 3.31) out of 48. After a multivariate analysis, only patient ethnicity (β= -0.142, p < 0.05) and increased consultation time (β = 0.407, p < 0.01) were associated with higher OPTION scores.
Conclusions:
Patients in Malaysia experience extremely poor levels of SDM in general practice. Higher scores were associated with increased consultation time and patient ethnicity.
Practice Implications:
Malaysian general practitioners should aim to develop and practice cultural competency skills to avoid biased SDM practice towards certain ethnicities.
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