HEALTH CARE MANAGERS' PERSPECTIVE ON SHARED DECISION MAKING IN SPAIN

Purpose: To know the acceptability and appropriateness to the Spanish Health System of three American patient decision aids (PtDAs) on type 2 diabetes, breast cancer and herniated disc from the perspective of a group of health care managers, with the aim to promote the shared decision making in Spain.

Method: The three PtDAs were developed by the Foundation for Informed Medical Decision Making (FIMDM) and translated into Spanish. The material was delivered in a booklet and DVD format. Thirteen health care managers analyzed the responses of 85 patients and 77 health care professionals in relation to the three PtDAs evaluated. The information was obtained in facilities of Governmental Health Departments in Madrid, Barcelona and Tenerife using qualitative methods: focus groups and semi-structured interviews. All sessions were audio taped, transcribed and codified with the Atlas Ti v.5.2. by means of an inductive process. The analysis categories were positive issues, aspects to adapt for its implementation, and context of application in Spain.

Result: The overall assessment of the PtDAs was quite positive, being widely accepted by all participants as a way to improve health care by involving patients in informed medical decisions. More specific comments on the PtDAs focused on the clarity and reliability of the information collected. The inclusion of actual patients sharing their experiences was greatly appreciated by all participants. However, the need for cultural adaptation of the materials was a theme that emerged in all groups, but there was no consensus on the issue. Beyond the specific characteristics that should be revised to implement these PtDAs in Spain, health care professionals stressed the need to assess the socio-demographic characteristics, attitudes, and informational needs of potential users. Finally, the health care managers identified several barriers to the implementation of the PtDAs in Spain: paternalistic view of the doctor-patient relationship, lack of financial resources and some organizational and operational aspects of the Spanish Health System.  

Conclusion: The analysis of the information provided by health care managers showed that, after a phase of cultural adaptation, the application of these PtDAs on type 2 diabetes, breast cancer and herniated disc in Spain would mean a change in the patient and caregiver relationship, stimulating the improvement of the sanitary infrastructure in Spain.