Factors Influencing Nurses’ Intention and Behavior in Shared Decision-Making: A Cross-Sectional Study

Abstract

Background: Shared decision-making (SDM), a cornerstone of patient-centered care, is associated with increased patient satisfaction and improved health outcomes. Nurses, as integral members of the health care team, play a pivotal role in SDM by advocating for patients and facilitating communication. However, their involvement in SDM is often constrained by systemic and organizational factors. Identifying the factors that significantly influence nurses’ engagement in SDM is essential to advancing SDM practice. Purpose: This study, guided by the theory of planned behavior (TPB), was designed to explore the factors of influence on the intentions and perceived behaviors of nurses related to SDM. Methods: A cross-sectional study was conducted on 159 nurses recruited through convenience sampling from 11 teaching hospitals in Taiwan. The data used in the analyses were collected using a self-administered questionnaire developed to measure the following TPB constructs: intention, attitude, subjective norms, perceived behavioral control, and perceived SDM behavior. Descriptive statistics, univariate analyses, and hierarchical linear regression were performed to examine the associations among TPB variables, intention, and perceived SDM behavior. Results: A significant correlation was identified between age and intention to engage in SDM (Pearson’s r = .250, p = .001). Participants with a master’s degree or higher qualification reported significantly stronger intention to participate in SDM than those holding either an associate or bachelor’s degree (3.58 vs. 1.29, p < .001). The mean perceived SDM behavior score was 12.86 (SD = 4.25). A hierarchical regression analysis found attitude (β = 0.40, p < .001) and perceived behavioral control (β = 0.35, p < .001) to significantly predict intention to engage in SDM (adjusted R 2 = .436, p < .001). In addition, all of the TPB variables were identified as significant predictors of perceived SDM behavior. The final regression model explained 48.8% of the variance (p < .001). Exhibiting a more positive attitude, greater perceived control, and stronger intention were each associated with having a higher level of perceived SDM behavior. Conclusions/Implications for Practice: The findings of this study underscore the importance of intention and behavior in the participation in SDM by nurses, with attitude and perceived behavioral control identified as key determining factors. Thus, these factors, together with intention to engage in SDM, significantly influence perceived SDM behavior. Hospital managers and educators should implement comprehensive strategies, including related initiatives, skill training, organizational support, and incentives, to increase participation by nurses in SDM.