Shared Decision-Making and Role Preference Among Patients With Schizophrenia in Malaysia: A Cross-Sectional Study

Abstract

Introduction: Shared decision-making (SDM) is recognized as a promising strategy for improving collaboration between clinicians and their patients in achieving recovery. In Malaysia, SDM among people with schizophrenia is still lacking both in practice and in research. This study aimed to determine the level of SDM and role preference and their associated factors among patients with schizophrenia in Malaysia.Methods: A cross-sectional study was conducted on 86 outpatient attendees with schizophrenia at a teaching hospital in Kuala Lumpur, Malaysia. The nine-item Shared Decision Making Questionnaire and Control Preference Scale were used to assess perceived SDM experience and role preference, respectively. Linear and logistic regression models were used to analyze the factors associated with SDM and role preference, respectively. Factors with a p <0.25 from the simple regression analyses were controlled as the covariates in the multiple regression analyses.Results: The study respondents were predominantly female, single, and unemployed, with a mean age of 44 years. Only 35% of the participants reported having high SDM experiences, even though the majority (56%) preferred autonomous role preference. Among the participants who preferred autonomous roles, only 40% experienced high SDM. High SDM was found to be significantly associated with being younger (B = −0.33, 95% CI = −0.67 to −0.003) and being non-clozapine users (B = 19.90, 95% CI = 9.39–30.41), while autonomous role preference was significantly associated with a lower level of insight [adjusted odds ratio (AOR) = 0.84, 95% CI = 0.72–0.99] and being on oral antipsychotic drugs only (AOR = 2.94, 95% CI = 1.10–7.82).Conclusion: The practice of SDM is still lacking in the treatment of patients with schizophrenia in Malaysia, even though many of them preferred to be involved in the decision-making pertaining to their treatment. This study indicates the need for clinicians to improve their patients' involvement in the treatment process. More research is needed on how SDM can be implemented in patients with schizophrenia, especially in Asian population settings.

Evidence for the Effectiveness of Psychological Interventions for Internalized Stigma among Adults with Schizophrenia Spectrum Disorders: A Systematic Review and Meta-Analyses

“…If Stereotype Endorsement and Alienation are a problem, then interventions such as NECT [ 48 ], Solution-focused Group Psychoeducation Program [ 49 ], Mindfulness-based Psychoeducation [ 44 ], or CBT-based psychoeducation program [ 47 ] that are known to effectively improve these targets may be utilized. Such tailored care may result in the following outcomes: an improved patient experience as a result of treatment decisions that take into account patients’ care needs and preferences; an improved population’s health and quality of life as a result of tailored care being supported; and a reduction in the per capita cost of care as a result of a reduction in the overuse, underuse, and misuse of healthcare services [ 68 ]. Furthermore, prior to implementing the intervention, it is essential to have a discussion about the options that are suitable and available, as well as the pros and cons of each, and to apply shared decision making between the patient and the doctor, as this may have many positive outcomes.…”

Gothenburg Empowerment Scale (GES): psychometric properties and measurement invariance in adults with congenital heart disease from Belgium, Norway and South Korea

“…Consideration of structural elements is relevant for the current study because the "shared decision-making" dimension had the lowest factor loadings for the South Korean sample, as well as poor reliability. Shared decision-making involves healthcare professionals and patients working together on a care plan [28]. It entails patients who are willing to participate as well as clinicians who want to collaborate with the patient.…”

“…Within Asian cultures, for example, it is more commonly believed that patients prefer to take a less independent role and that a family-centered (rather than individualcentered) approach towards decision-making is preferred [29][30][31]. It has been suggested that shared decisionmaking reflects values associated with western cultures and that this might be different in other cultures [28,31,32]. The value placed on shared decision-making and the structure of the healthcare system might therefore potentially impact the value of patient empowerment as perceived by study participants.…”

Shared decision-making in Malaysia: Legislation, patient involvement, implementation and the impact of COVID-19

“…Since SDM research was first initiated in Malaysian in 2010, there has been an increase in activity and focus on SDM. This is exemplified by a growing body of published studies on the subject and an increasing number of PDAs from Malaysia in fields as diverse as mental health [1] , [2] , primary care [3] , pharmaceutical consultations [4] , surgery [5] and genetics [6] . From a policy perspective, guidelines now emphasize in more detail how doctors are expected to communicate risks during consultations with patients [7] .…”