Factors associated with level of shared decision making in Malaysian primary care consultations

Objective: To measure the level of shared decision-making (SDM) in primary care consultations in Malaysia, a multicultural, middle-income developing country. Methods: A cross-sectional study was conducted in an urban, public primary care clinic. Convenience sampling was used to recruit participants, and audio-recorded consultations were scored for SDM levels by two independent raters using the OPTION tool. Univariate and multivariate analysis was conducted to determine factors significantly associated with SDM levels. Results: 199 patients and 31 doctors participated. Mean consultation time was 14.3 min (+/- SD 5.75). Patients' age ranged from 18 to 87 years (median age of 57.5 years). 52.8 % of patients were female, with three main ethnicities (Malay, Chinese, Indian). The mean OPTION score was found to be 7.8 (+/- SD 3.31) out of 48. After a multivariate analysis, only patient ethnicity (beta= -0.142, p < 0.05) and increased consultation time (beta = 0.407, p < 0.01) were associated with higher OPTION scores. Conclusions: Patients in Malaysia experience extremely poor levels of SDM in general practice. Higher scores were associated with increased consultation time and patient ethnicity. Practice implications: Malaysian general practitioners should aim to develop and practice cultural competency skills to avoid biased SDM practice towards certain ethnicities. (C) 2019 Elsevier B.V. All rights reserved.