Shared Decision Making among Patients with Chronic Conditions in France: A Cross-Sectional Survey in the ComPaRe E-Cohort

BackgroundShared decision making (SDM) is a cornerstone of patient-centered care; however, little information is available on how SDM is practiced in routine care. We aimed to assess the level of SDM perceived by patients with chronic conditions for the most important health decision in the past 12 mo.MethodsThis was a cross-sectional online survey among ComPaRe, a nationwide e-cohort of patients with chronic conditions in France. The survey asked participants about their perception of SDM using the 9-item Shared Decision-Making Questionnaire (SDM-Q-9) regarding their most important health decision in the past 12 mo. We weighted the sample to represent French patients with chronic conditions and conducted regression models to identify factors associated with higher SDM levels, adjusting for sociodemographic and clinical characteristics.ResultsIn total, 2,087 patients were analyzed (participation rate: 34.9%). In the weighted sample, 53.0% were women, the mean (SD) age was 51.0 (15) y, and the most frequent conditions were endometriosis (27.3%), inflammatory rheumatic diseases (20.7%), and high blood pressure (19.3%). The most important health decisions in the past 12 mo were mainly about drug treatments (36.5%) or surgery (20.5%). The mean (SD) SDM-Q-9 score was 63 (27)/100 (moderate level of SDM). The highest scores were observed for cancer (70 [26]) and depression (69 [26]), whereas the lowest scores were for long COVID (54 [28]) and endometriosis (58 [25]). Decisions about surgery (71 [25]) and with specialists (64 [27]) were associated with higher scores compared with medication decisions (60 [28]) or with general practitioners (62 [27]). Multivariate analysis confirmed that a higher SDM level was associated with being a man; having higher health literacy; making decisions relating to cancer, surgery, or medical devices; and specialist involvement.ConclusionsPatients with chronic conditions in France report moderate levels of SDM, with substantial variations by condition, decision type, and patient characteristics. Findings highlight the need for tailored strategies to foster SDM in chronic care.HighlightsShared decision making (SDM) is considered a key component of the chronic disease management model.This study provides the first nationwide assessment of perceived SDM levels among patients with chronic conditions in France.Patients have a moderate overall SDM score, but significant disparities exist. Patients with less recognized conditions such as long COVID or endometriosis, low health literacy, and high treatment burden reported significantly lower SDM scores as compared with others in their care decisions.These findings underscore the need for targeted interventions to improve SDM implementation.