In mainstream healthcare systems in the Netherlands, “shared decision-making” is well known. This involves patients in treatment choices, with doctor and patient deciding together which diagnostics and treatments are best. This generally leads to higher patient engagement and better health outcomes. However, the patient population of Kruispost differs from that of mainstream care. To what extent can we apply shared decision-making to patients with a language barrier or unfamiliarity with the system?
For her research, Stella spoke with 14 physicians at Kruispost to find out how often shared decision-making is used and what factors influence it. Her conclusions are clear: among undocumented and uninsured patients, shared decision-making is hardly ever used.
There are several reasons for this. Physicians experience barriers such as language, lack of intercultural affinity, workload and a missing doctor-patient relationship. For patients, the language barrier, limited communication skills, cultural influences, priorities, limited health literacy and unfamiliarity with Dutch system are though hurdles.
How do we promote shared decision-making now that we know this? According to Stella, at the local level at Kruispost, increased awareness of the impeding factors is essential. This allows physicians to adjust their expectations and take a more inclusive approach to decision-making processes. An inclusive approach is also needed at the system level, with government funding, interpreter services and culturally-sensitive care delivery.
Read Stella’s master’s thesis (Care Management; Dutch) here.
