The role of nurses in shared decision-making in primary care: Qualitative study.

Objective

To explore the primary care nursing professionals (PCN) perception of their role in Shared Decision Making (SDM) to improve the adherence in patients with chronic pathology and a new cardiovascular and/or diabetes with new pharmacological prescription.

Methods

A descriptive qualitative study was conducted with the participation of 19 primary care nurses from two primary care centres in the Southern Metropolitan health region of Barcelona during 2022. The participating primary care nurses had to be part of the intervention group of the IMA-cRCT clinical trial. Narrative data were collected through focus groups using a semistructured guide and carried out in two phases. Phase I took place after a training on SDM but before the implementation of an SDM intervention aimed at improving primary medication adherence, during which 3 focus groups were conducted. Phase II was carried out 7 months after the intervention implementation with 2 additional focus groups. For the thematic content analysis, all focus groups were transcribed, analysed individually, and triangulated. Nvivo 15 software was used to support the analysis. All participants signed informed consent forms, and the interviews were pseudo-anonymised.

Results

Seven themes were identified that illustrated the PCN perspective when implementing SDM in the approach to the chronic patient with new pharmacological prescriptions: Model of care; Patient characteristics; PCN attitude; Interdisciplinary coordination; Prior training; Resources and opportunities for improvement. No relevant differences were identified in the pre-post discourses of the participants.

Conclusions

The integration of SDM in the role of PCN is key in accompanying the health care of chronic patients. This study shows that they have not yet incorporated it into their routine. DBT requires university and continuing education, interdisciplinary coordination and a change of paradigm at all levels.