Experiences and ethical issues during shared decision-making in rural healthcare: A case of Budumba and Butaleja HC III, Uganda

Abstract

Background: Shared decision-making (SDM) in healthcare is a collaborative process where patients are supported to make informed decisions according to their preferences. Healthcare decisions affect patients' lives which necessitates patients to participate in decisions concerning their health. This study explored experiences and ethical issues related to SDM in a rural healthcare setting. Methods: An exploratory qualitative study was conducted at Budumba Health Centre III and Butaleja Health Centre III in rural Eastern Uganda. In this study, 23 in-depth interviews were conducted among 12 healthcare providers and 11 patients. Data was analyzed thematically using NVivo-12 plus software. Results: Four themes emerged which included: experiences, challenges, strategies for improvement, and ethical issues. Patients at both facilities expressed the need to be involved in decision-making processes. However, many stressed that they are not engaged in decision-making about their health. Many healthcare providers noted that SDM could improve patient prognosis but are faced with challenges related to low male involvement and the influence of cultural and religious practices, including myths and patriarchal attitudes that impact effective patient engagement. Ethical issues included concerns about informed consent, privacy and confidentiality, deception, and harm. This study highlighted the need for better sensitization of patients and comprehensive training for HCPs to minimize and resolve ethical issues that emerge during SDM processes. Conclusion: Despite the recognized benefits of SDM in improving patient outcomes, significant barriers persist in rural healthcare, including cultural and religious influences, low male involvement, and ethical concerns related to informed consent, privacy, and confidentiality. Therefore, this study underscores the need for enhancing SDM practices in rural healthcare settings. Recommendation: There is a need for targeted patient sensitization and comprehensive training for healthcare providers to facilitate meaningful engagement that fosters more effective and ethical SDM processes, ultimately improving patient care in rural settings.