Shared Decision-Making on Life-Sustaining Treatment: A Survey of Current Barriers in Practice Among Clinicians Across...

Background: The perceptions of practicing physicians regarding the current situation and appropriateness of shared decision-making (SDM) in life-sustaining treatment (LST) are of essential importance. The objective of this study is to investigate the clinical practice patterns and barriers to this process in China. Methods: A cross-sectional survey of physicians in China was conducted to assess perceived practices of SDM in LST. The survey instrument was developed through the Delphi method. Descriptive analyses and an exploratory factor analysis were performed to explore the correlations of factors. Results: We polled 977 physicians, of whom 971 completed the survey and 834 (85.9%) have experience of decision-making conversations for LST and entered the final analysis. Physicians expressed that in the process of doctor-patient communication, over-expectations of disease prognosis (778 [93.3%]), lack of general medical knowledge (716 [85.9%]), and negative emotional status (574 [68.8%]) served as the main barriers to decision-making communication from the patient/family side, while under-expressed patient value (429 [51.4%]), limited communication due to work-load (359 [43%]), lack of communication skills (310 [37.2%]), and insufficient ability to cope with difficult cases (203 [24.3%]) as obstacles from the physician side. Only 185 (22.2%) physicians chose to disclose medical information according to literature evidence. The direct effects of physician service year and disclosure pattern on patient/family decision-making ability revealed statistically significant correlations (β_{DMA = 0.08, p = 0.035; βDMA = 0.40, p < 0.001), as did the effect of disclosure pattern on patient value expression (βPV = 0.88, p < 0.001). Conclusions: From physicians' perspective, barriers of decision-making conversations correlated with multiple factors, including under-expressed patient value, insufficient patient/family decisional capacity or ability, and experience and communication patterns of physicians.}