Cultural impacts on shared decision-making: A cross-European study of psychiatrist preferences in 38 countries

Shared decision-making (SDM) is a collaborative process between clinicians and service users to select treatment, guided by evidence and service user preferences. SDM has clinical, economic, and ethical benefits compared to clinician-led decision-making; yet, implementation remains challenging. An important knowledge gap is the influence of culture on implementation. Cultural impacts on service user decision-making preferences have been documented, but little is known about how culture impacts clinician preferences. This study examined associations between country-level cultural characteristics and decision-making preferences of psychiatrists in routine care settings across Europe.

We analysed data from 751 psychiatrists and trainees in 38 European countries, who completed the Clinical Decision-Making Style-Staff (CDMS-S) scale. Country-level Hofstede cultural dimensions were linked to CDMS-S scores using univariate and multivariate regression models. Mixed-effects models were used to account for country-level clustering and controlling for professional and economic variables.

In univariate analyses, all six dimensions were associated with SDM preferences. However, only three remained significant in mixed-effects models. Higher levels of Indulgence and Individualism were associated with stronger preferences for SDM, while higher Power Distance was associated with more clinician-led decision-making. These associations did not remain significant in fully adjusted multivariate models, suggesting professional and systematic factors mediate cultural influences.

Indulgence, Individualism, and Power Distance are associated with psychiatrists' decision-making preferences across Europe. Culturally sensitive SDM interventions should address not only clinician attitudes but also healthcare structures and patient expectations. Findings offer an empirical foundation for tailoring SDM training and policy to diverse cultural contexts within European psychiatry.