Differences in shared decision-making: the East-West divide

Cultural sensitivity plays an essential role in SDM. Different cultural values might lead to diverse perceptions about autonomy and the role of family members in decision-making processes. SDM, primarily developed and refined within Western societies, was transposed to Eastern cultures with limited regard for cultural nuances. In the context of Chinese healthcare, family-centred decision-making is prevalent.7 Family understanding of health and illness is based on the interplay of individual experiences and the broader cultural framework. Studies suggest that most cultural groups in Asia may expect higher levels of family involvement in medical decision-making8 than in Western cultures, due to regional sociocultural values emphasising family support, and care and respect for family and elders.9 Religious beliefs in some regions further underscore the importance of family cohesion.7 Likewise, in the Chinese context, family members frequently assume a crucial part in medical decisions, occasionally deciding for the patient. Owing to the nuances of traditional Chinese culture, influenced by multifaceted philosophies such as Confucianism,10 and the intricate societal dynamics, the scope of SDM in China often extends beyond the immediate stakeholders. In many instances, decision-making rights might encompass clans or extended families. In some cases, the pivotal factors influencing decisions could even stem from neighbouring patients or anecdotes from distant relatives in the family. © Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.