Special Issue / Schwerpunkt
Call for shared decision making in China: Challenges and opportunitiesAufruf zu partizipativer Entscheidungsfindung in China: Herausforderungen und Chancen

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Abstract

China's healthcare system has undergone extensive changes over recent years and the most recent reforms are designed to shift the emphasis away from hospital based services towards a more primary care based system. There is an increasing recognition that shared decision making needs to play a central role in the delivery of healthcare in China, but there are several significant barriers to overcome before this aspiration becomes a reality.

Doctor-patient relationships in China are poor, consultations are often brief transactions and levels of trust are low. Implementing a shared decision making process developed in the Western World may be hampered by cultural differences, although this remains an under-researched area. There is, however, a suggestion that the academic community is starting to take an interest in encouraging shared decision making in practice and indications that the Chinese public may be willing to consider this new approach to healthcare.

Zusammenfassung

Das chinesische Gesundheitssystem hat sich im Laufe der letzten Jahre stark gewandelt; die jüngsten Reformen sollen den Schwerpunkt von einer krankenhausbasierten Versorgung hin zu einem stärker auf dem Konzept der Primärversorgung beruhenden System verlagern. Die Erkenntnis wächst, dass partizipative Entscheidungsfindung in der chinesischen Gesundheitsversorgung eine zentrale Rolle wird spielen müssen, doch bevor sich diese Bestrebungen realisieren lassen, gilt es, einige wesentliche Hürden zu überwinden.

Um die Arzt-Patient-Beziehung ist es in China schlecht bestellt; der Arztbesuch ist häufig eine kurze Angelegenheit mit niedrigem Vertrauensniveau. Die Implementierung des Prozesses der partizipativen Entscheidungsfindung, wie er in der westlichen Welt entwickelt wurde, könnte aufgrund der kulturellen Unterschiede auf Schwierigkeiten stoßen, wobei dieses Thema bislang allerdings noch unzureichend erforscht ist. Es gibt jedoch Hinweise darauf, dass die akademische Community sich für die Förderung von partizipativer Entscheidungsfindung in der Praxis zu interessieren beginnt, und auch Anhaltspunkte dafür, dass die chinesische Öffentlichkeit möglicherweise bereit ist, über diese neue Herangehensweise an die Gesundheitsversorgung nachzudenken.

Section snippets

An overview of medical and health services in China

There are four important stages in the development of China's healthcare.

Between 1949 and 1984, the government owned and operated all healthcare facilities and employed the healthcare workforce. In this system, China used community health workers to provide basic public and personal health services at the village level. In the 1980s, the Chinese government initiated a major reform of the medical and healthcare systems. The role of the government in healthcare was dramatically reduced and a

Doctor-Patient relationships

Structural imbalances and ongoing system transformation have had an important effect on the doctor-patient relationship. A large, national survey in 2008 found that 80% of medical professionals considered the doctor-patient relationship to be poor or very poor [9]. An unfortunate manifestation of this is seen in the large number of violent incidents perpetrated against doctors. One survey in 2012 found that 96% of medical staff reported abuse or injury [10] and concerns over violence are a

Shared decision making in China

In 2015, a review by Huang et al searched multiple sources for evidence of shared decision making in China, but could not find any sign of the development, testing, or implementation of shared decision making tools for patients in Mainland China [18]. They concluded that shared decision making may be out of China's reach in the current environment due to insufficiencies and inequities in the healthcare delivery system, low health literacy of the Chinese populations, extremely brief clinical

Cultural considerations

Shared decision making is a paradigm that has been developed and refined largely in the context of Western society. It is questionable to assume that this can be simply transposed onto the Chinese Culture. We must consider the cultural challenges associated with engaging Chinese patients in shared decision making in order to make this technique meaningful to patients [31]. The traditional Chinese culture is based on diverse and competing philosophies founded in Confucianism. Within such a

Barriers to shared decision making in China

In addition to the general cultural considerations outlined above, there are specific aspects of the medical system in China that may impede adoption of shared decision making. Firstly, there is a lack of appreciation for medical humanities in Chinese medical society. This results in limited recognition of the importance of patient-centered care and the principals of medical ethics amongst medical students and staff. Therefore the values that underpin the foundations of shared decision making

The future of shared decision making in China

The successful implementation of shared decision making in China could present a substantial challenge. Although there are an abundance of tools to aid shared decision making internationally, to adapt these for China and evaluate their uses will require time and resources, as well as commitments from relevant organisations. There would also be a need for research on the acceptability, long-term effectiveness and costs of patient decision aids in China. Implementation of decision aids would have

Conflict of Interest

None declared.

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