• Rachel Zeuner, Dominick L Frosch, Marie D Kuzemchak, and Mary C Politi.
• Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
• Health Expect. 2015 Dec 1; 18 (6): 2465-76.

BackgroundShared Decision Making (SDM) is a process of engaging patients in health decisions that involve multiple medically appropriate treatment options. Despite growing public and policy support for patient engagement in health decisions, SDM is not widely practiced in clinical settings.ObjectiveThe purpose of our study was to explore clinicians' attitudes, beliefs and perceived social norms about engaging in SDM behaviours.DesignSemi-structured qualitative interviews were conducted with physicians in five practice areas.Setting And ParticipantsThis study was conducted at an academic medical centre in St. Louis, MO. The final sample included 20 physicians: five surgeons, five OB/GYNs, four medical oncologists, five internists and one emergency medicine physician.ResultsClinicians described a number of beliefs and cultural- and system-level obstacles to the widespread implementation of SDM, such as how to engage in discussions of cost, uncertainty and clinical equipoise and how to engage patients across various socioeconomic backgrounds.ConclusionAlthough a large number of participants expressed general support for incorporating SDM into practice, most held fundamentally inconsistent beliefs about practicing specific SDM behaviours. More extensive training of physicians at all levels (pre- and post-licensure) can help increase clinicians' confidence in SDM skills. Developing methods of integrating SDM into the institutional framework of hospitals and training programmes could also increase clinicians' motivation to practice SDM and work to change the culture of medicine such that SDM behaviours are supported.© 2014 John Wiley & Sons Ltd.

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