How ‘Shared’ is Shared Decision Making? The Influence of COPD Features on Healthcare Professionals’ Perceptions: A Cohort Vignette Study

Better understanding of how healthcare professionals (HCPs) judge patients’ capability for shared decision making (SDM) is needed to ensure fair access to collaborative care, particularly for patients with complex chronic conditions. This study examined the influence of 19 features of patients with Chronic Obstructive Pulmonary Disease (COPD) and comorbidities on 1) HCPs’ perceptions of SDM capability and 2) their preference to receive technical support during a SDM process. Feature importance was assessed in a vignette study where 49 HCPs judged 12 vignettes each, yielding 587 judgments. SHAP analysis showed that positive treatment attitude, higher educational level, good COPD knowledge, and native language strongly shaped HCPs’ perceptions of patients’ SDM capability. Negative treatment attitude, poor health literacy, poor COPD knowledge, low self-efficacy, and lack of social support strongly increased HCPs’ preference for technical SDM support. The low intraclass correlation ICC(1) score of 0.145 suggests considerable variation between individual HCPs in assessing patients’ SDM capability. Yet, the high ICC(1,k) score of 0.892 indicates strong overall agreement. These insights provide a valuable basis for understanding professional judgments but also reveal potential biases that may foster unequal SDM practices. Future research should focus on technical SDM support tools to promote more equitable, patient-centered SDM.