Zhiyi Zhao, Mei Du, and Guosheng Wang
Shared decision-making (SDM) is a promising approach to delivering patient-centred care for individuals with multimorbidity. It can help mitigate the risks associated with polypharmacy, reduce treatment burden, and enhance care continuity. However, existing SDM research seldom addresses the specific needs of multimorbid patients and has achieved only limited integration within China’s complex, tiered healthcare system. The medical experience of multimorbidity patients is fragmented and unsatisfying. Few studies provide actionable guidance on how to design and implement SDM services tailored to the Chinese context. This study therefore represents an initial step towards understanding and characterising the SDM service system. By adopting a systems approach, it seeks to identify the system’s core components and operational dynamics, while exploring the distinctive decision-making features, scenarios, and potential implementation challenges within China’s clinical environment.
Findings indicate that China’s SDM service system for multimorbidity comprises nine interdependent system components. From a stakeholder relationship perspective, these interactions produce three identifiable SDM decision-making models: the specialist-led single-disease model, the cross-departmental collaborative model, and the long-term co-managed model. From the temporal perspective of disease progression, the system maps illustrate four evolving SDM scenarios, ranging from initial-stage dyadic communication with clear responsibilities to later-stage shifting towards more intricate decision-making contexts, where roles and responsibilities become less clearly defined. These visual maps reveal challenges such as discontinuity of care, underdeveloped mechanisms for care coordination, and the absence of a clear decision coordinator role.
This study provides a foundational framework for understanding and describing the SDM service system for multimorbidity in China. It supports designers and policymakers in grasping the complexities of SDM implementation and the evolving dynamics of doctor-patient relationships. Moreover, the study advocates for a coordinated and inclusive transformation of SDM services for patients with multimorbidity. Its findings provide valuable guidance for the design and development of SDM services and decision aids tailored to the specific characteristics of the Chinese healthcare context.
Keywords: multimorbidity, shared decision-making, healthcare system, service system, system design, system analysis RSD: Health & Well-Being, Mapping & Modelling Introduction