Shared decision making in inflammatory bowel disease: a qualitative study with patients, gastroenterologists, and...

Shared decision making (SDM) is a key component of patient-centered care and is increasingly emphasized in the management of inflammatory bowel disease (IBD). However, insights into the implementation of SDM in IBD care and influencing factors remain limited. This study aimed to (1) investigate the implementation of SDM in IBD clinical practice, including the role of the IBD nurse in this process, and (2) identify barriers and facilitators for implementation.

Semi-structured interviews were conducted with IBD patients (n = 15), gastroenterologists (n = 11), and IBD nurses (n = 12) across Belgium. Interviews were transcribed verbatim and analyzed using a thematic framework method.

While gastroenterologists reported routinely incorporating most SDM steps into practice, patients described inconsistencies, particularly around emotional support, clarity of information, and elicitation of preferences. Participants viewed IBD nurses as essential partners in the SDM process, complementing the role of gastroenterologists by reinforcing information, facilitating communication, and addressing patients' physical, emotional, and social needs. Low health literacy and disease-related knowledge among patients, poor communication, and time constraints emerged as major barriers. In contrast, key facilitators were the perceived clinical and relational benefits of SDM, greater awareness of SDM, and enhanced education for both patients and providers.

Although SDM is recognized in IBD care, its implementation remains inconsistent due to structural and interpersonal barriers. Results from this study point toward the need for SDM training and organizational changes, such as recognizing and further strengthening the role of the IBD nurse in the SDM process. Demonstrating and promoting the intrinsic and consequential benefits of SDM, such as improved care quality, patient adherence, and professional fulfillment, may further support its widespread adoption. These findings can inform multi-stakeholder strategies for embedding SDM more consistently in IBD care.