Patient Decision Aids for insulin initiation face significant barriers in China, including knowledge gaps and role ambiguity among healthcare professionals.

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder requiring careful management. When oral antidiabetic drugs become insufficient, patients face the critical decision of initiating insulin therapy, a choice often met with anxiety, misconceptions, and potential non-adherence. Shared decision-making (SDM) is essential to empower patients to make informed, preference-congruent choices, thereby improving treatment outcomes and quality of life. Patient Decision Aids (PtDAs) are tools designed to facilitate SDM for complex medical decisions like insulin initiation. However, despite their proven benefits, the implementation of PtDAs in China remains significantly challenging, with a limited understanding of the specific contextual barriers hindering their adoption. This study aims to bridge that knowledge gap.

Researchers conducted a qualitative descriptive study utilizing semistructured interviews, guided by the Theoretical Domains Framework (TDF), to explore perspectives on PtDA implementation for insulin initiation. A purposive sample of 26 participants was recruited from a university-affiliated hospital in Beijing, China. This sample included 10 patients with T2DM, 6 endocrinologists, and 10 nurses. Interviews were meticulously audio-recorded, transcribed verbatim, and subsequently analyzed using a rigorous framework analysis approach, with assistance from NVivo software, to systematically identify recurring themes, barriers, and facilitators.

The study identified a comprehensive set of barriers and facilitators impacting PtDA implementation. For healthcare professionals, 15 distinct barriers and 5 facilitators were uncovered. Patients, in turn, reported 6 barriers and 5 facilitators. A prominent barrier for both groups was a significant lack of knowledge regarding PtDAs and insufficient practical skills for their effective use. Furthermore, issues related to social and professional roles emerged as critical:

Physicians frequently self-identified as the sole "decision-makers," marginalizing patient input, while nurses expressed considerable role ambiguity concerning their involvement in SDM. Organizational challenges also played a substantial role, including the absence of formal reinforcement mechanisms for PtDA use and concerns about increased workload coupled with limited resources. Conversely, key facilitators included healthcare professionals' positive beliefs about the beneficial consequences of PtDAs and the notable readiness of nurses, whose established roles in health education position them as potential champions for successful implementation. Patients also demonstrated a positive intention to use PtDAs, suggesting a receptive audience if barriers are addressed.