Discordance between observer and patient-reported shared decision-making in inflammatory bowel disease: A multicenter cross-sectional study

Abstract

Background:
Inflammatory bowel disease (IBD) is a chronic inflammatory disorder affecting the gastrointestinal tract. Optimal management of this condition requires collaboration between patients and physicians, a process known as shared decision-making (SDM). In this study, we aim to evaluate the quality of SDM in gastroenterology clinics in the Eastern Province of Saudi Arabia.


Methods:
This multicenter, cross-sectional study was conducted between September 2024 and December 2025. Audio recordings of gastroenterology visits were independently assessed by two reviewers using the validated Observing Patient Involvement in Decision-Making (OPTION-5) scale. Moreover, patients evaluated their encounters using the 9-item SDM Questionnaire (SDM-Q-9). A multivariable regression analysis was performed to determine independent predictors of SDM from both the patient and physician perspectives.


Results:

A total of 105 encounters from three hospitals were analyzed with a median OPTION-5 score of 5 out of 100 (IQR 0–10). A multivariate linear regression analysis showed that longer consultation duration in minutes (
β
= 1.88, 95% Confidence Interval (CI): 0.21–3.56,
P
= 0.028) and the decision to start a new medication (
β
= 24.86, 95% CI: 17.24–32.48,
P
< 0.001) were independently associated with higher total OPTION-5 scores. There was no significant correlation between observer-rated OPTION-5 scores and patient-reported SDM-Q-9 scores (Spearman’s
ρ
= –0.044,
P
= 0.687), indicating discordance between externally assessed and patient-perceived shared decision-making.



Conclusion:
In this cohort of patients with IBD from three centers in the Eastern Province of Saudi Arabia, observer-rated SDM was low. Multiple factors were significantly associated with the level of SDM, including longer consultation duration and decision to start new medication. Further studies to determine interventions that can enhance SDM are warranted.