Patients' Perceptions and Experiences of Shared Decision-Making in Primary HIV Care Clinics

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• 作者：Shannon M. Fuller ; MS ; ^{Shannon.Fuller@ucsf.edu}Author Vitae ; Kimberly A. Koester ; MAAuthor Vitae ; Ryan R. Guinness ; MDAuthor Vitae ; Wayne T. Steward ; PhD ; MPHAuthor Vitae
• 关键词：HIV care ; patient-centered medical home ; qualitative research ; shared decision-making
• 刊名：Journal of the Association of Nurses in AIDS Care
• 出版年：2017
• 出版时间：January-February 2017
• 年：2017
• 卷：28
• 期：1
• 页码：75-84
• 全文大小：145 K
• 卷排序：28

文摘

Shared decision-making (SDM) is considered best practice in health care. Prior studies have explored attitudes and barriers/facilitators to SDM, with few specific to HIV care. We interviewed 53 patients in HIV primary care clinics in California to understand the factors and situations that may promote or hinder engagement in SDM. Studies in other populations have found that patients' knowledge about their diseases and their trust in providers facilitated SDM. We found these features to be more nuanced for HIV. Perceptions of personal agency, knowledge about one's disease, and trust in provider were factors that could work for or against SDM. Overall, we found that participants described few experiences of SDM, especially among those with no comorbidities. Opportunities for SDM in routine HIV care (e.g., determining antiretroviral therapy) may arise infrequently because of treatment advances. These findings yield considerations for adapting SDM to fit the context of HIV care.