Barriers and Facilitators for Shared Decision Making in Breast Reconstruction among Stakeholders in the Chinese...

Objective. This qualitative study explores the barriers and facilitators to implementing shared decision making (SDM) for breast reconstruction (BR) from multistakeholder perspectives in the Chinese health care context. Methods. A qualitative study was conducted from November 2021 to January 2022, involving 36 participants, including patients, doctors, nurses, and hospital administrators from 3 tertiary hospitals in Beijing, Hebei, and Guangzhou. Purposeful and snowball sampling was used until data saturation. In-depth semi-structured interviews were analyzed using thematic analysis. Results. Findings from 36 stakeholders (20 patients, 16 health care providers/administrators) revealed 5 key dimensions influencing SDM implementation: decision making, patient, health care professional (HCP), organizational, and societal levels. Notable factors include patient self-efficacy, information needs, HCPs' role recognition and SDM competencies, team coordination, SDM convenience, availability of support tools, and cultural influences. Limitations. The limitations of this study primarily stem from the narrow sample source, which includes only 3 regions in mainland China. Conclusion. Successful SDM implementation in China requires optimizing clinical workflows, utilizing technological tools, providing professional training, and integrating SDM with traditional Chinese medicine philosophies. These strategies enhance decision-making quality and align SDM practices with Chinese cultural values. Practice Implications. Integrating culturally sensitive SDM into clinical workflows, supported by decision tools, training, and robust policies, is essential for BR SDM in China.

Identified barriers and facilitators on shared decision making for breast reconstruction from multistakeholder perspectives in China's health care context.Explored cultural influences on shared decision making for breast reconstruction in Chinese patients.Emphasized the importance of integrating shared decision making into existing clinical workflows.Proposed integrating traditional Chinese medicine diagnostics with shared decision making for culturally sensitive care.