“Breaking the Silence”: A Qualitative Study Exploring How to Improve Surgical Shared Decision Making for Underserved Groups

Background High quality shared decision making (SDM) is recognised as a cornerstone of modern medical practice, and increasing patient involvement is a key priority in health policy. Approximately 312.9 million patients undergo surgery in the world each year. Effective SDM is crucial for all these patients, yet existing SDM interventions disproportionately benefit individuals with higher education levels, better health literacy, and greater socioeconomic advantage. This qualitative study explored patient experiences of SDM and their views on how to improve it, with particular attention to the needs of marginalised groups. Methods Employing a qualitative study design, face-to-face or remote semi-structured interviews were conducted with community members in two UK locations: the Yorkshire and Humber region, mainly centred in Bradford, and Bristol. We adopted purposive sampling to explore the views of individuals experiencing intersectional health inequalities due to older age, ethnic minority and economically disadvantaged background. Transcripts were thematically analysed using an inductive approach. Results The findings from 31 interviews consist of three main themes on underserved groups’ perceptions about NHS and healthcare professionals, capacity of patients to engage in SDM, feeding back of SDM experience. Notably, the findings highlight that inadequately designed SDM processes and structural barriers fail to accommodate the capacities and needs of underserved patients. Feeding back of the patient’s experience using non-digital (verbal, telephonic or paper based) and multi-lingual options to identify where effective SDM fails and making SDM process adaptive and tailored to the needs of patients are suggested as ways to improve SDM for underserved groups. A set of recommendations to make SDM more equitable are provided. Conclusions Addressing the unique challenges faced by underserved groups in SDM requires a multifaceted approach that includes enhancing communication, building trust, addressing technological barriers, and respecting cultural values. The insights from participants highlight the need for tailored interventions and flexible, inclusive strategies to ensure equitable and effective SDM for all patients. The findings from this study will inform the design of a decision support intervention to improve SDM before surgery.