Experiences and perspectives related to shared decision-making among outpatients with degenerative joint disease in Taiwan: a qualitative study

Yeu Hui Chuang, Chih Chien Wang, Chih Yin Hsiao, Chien Yeh Lu, Jeng Cheng Wu, Wen Hsuan Hou

Research output: Contribution to journalArticlepeer-review


Objectives Various treatment options are available for degenerative joint disease (DJD). During clinical visits, patients and clinicians collaboratively make decisions regarding the optimal treatment for DJD; this is the essence of shared decision-making (SDM). Here, we collated and assessed the SDM-related experiences and perspectives of outpatients with DJD in Taiwan. Design In-depth interviews and thematic analysis. Setting Primary care clinics of a regional teaching hospital in Taiwan, October 2021-May 2022. Participants 21 outpatients with at least three visits for DJD and who were aware of SDM. Results Four main themes emerged in this study: first, equipping themselves with knowledge: outpatients obtained disease-related and treatment-related knowledge in various ways - seeking relevant information online, discussing with family and friends, learning from their own experiences or learning from professionals. Second, shared or not shared: physicians had different patterns for communicating with patients, particularly when demonstrating authority, performing mutual discussion, respecting patient preferences or responding perfunctorily. Third, seldom saying no to physician-prescribed treatment plans during clinical visits: most patients respected physicians' professionalism; however, some patients rejected physicians' recommendations indirectly, whereas some responded depending on their disease prognosis. Fourth, whose call? - participants decided to accept or reject a treatment plan independently or by discussing it with their families or by obeying their physicians' recommendations. Conclusions In general, patients with DJD sought reliable medical information from various sources before visiting doctors; however, when having a conversation with patients, physicians dominated the discussion on treatment options. The patient-physician interaction dynamics during the SDM process determined the final medical decision, which was in accordance with either patients' original autonomy or physicians' recommendations. To alleviate medical paternalism and physician dominance, patients should be empowered to engage in medical decision-making and share their opinions or concerns with their physicians. Family members should also be included in SDM.

Original languageEnglish
Article numbere075693
JournalBMJ Open
Issue number2
Publication statusPublished - Feb 2 2024


  • Clinical Decision-Making
  • Patient Participation
  • Patient-Centered Care

ASJC Scopus subject areas

  • General Medicine


Dive into the research topics of 'Experiences and perspectives related to shared decision-making among outpatients with degenerative joint disease in Taiwan: a qualitative study'. Together they form a unique fingerprint.

Cite this