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Shared decision making (SDM) is advocated as an approach for patient-centred asthma care. However, this approach may not always be feasible or preferred by patients and/or healthcare professionals (HCPs). Knowledge and insights into whether and how the preferred collaboration style in medical decision making is discussed and managed during consultations for severe asthma are limited.
To investigate how HCPs’ and patients’ preferred collaboration styles in treatment decision making are experienced, discussed and managed during consultations.
Qualitative research using semi-structured interviews with HCPs specialised in severe asthma and a focus group with severe asthma patients in The Netherlands. Inductive thematic analysis was used, with results reported according to the COREQ checklist.
Four themes concerning HCPs’ and patients’ experiences were identified: (1) overall preference for SDM, yet (2) ambiguity of SDM’s content, (3) variation in application of SDM and (4) friction between medical focus and patient autonomy in SDM. A fifth theme concerned the discussion and management of collaboration style preferences: limited metacommunication. HCPs and patients seem unable to identify each other’s preferences in collaboration styles. Overall, a lack of communication regarding how to collaborate in making treatment decisions was found. Varying views on meaning and content of collaboration styles, especially SDM, and HCPs’ medical focus seemed to contribute to the lack of communication.
With the lack of communication regarding preferences in collaborating, HCPs and patients are likely to miss out on effective collaboration. Future studies should explore how views and preferences regarding HCP-patient collaboration can be bridged.
This study aims to describe current nurse prescribing practices in the absence of a legal framework, evaluate healthcare providers' preferred prescribing models, and their perceptions of the impact of nurse prescribing in Belgian hospitals.
Multicentre quantitative, cross-sectional survey.
Between December 2022 and April 2023, healthcare providers from seven Flemish hospitals completed an online survey after being presented with a short explanatory video on independent and supplementary nurse prescribing. The survey assessed demographics, current practices, expected impact and preferred prescribing models.
Of the 303 respondents, 86% were nurses, 10% were medical doctors and 4% were pharmacists.
Independent nurse prescribing or deprescribing of medications was reported by 75% in their current work context. Nurse prescribing was observed weekly or daily by 48%, primarily for initiating new medications. Overall, 44% preferred independent nurse prescribing over no prescribing.
Despite the absence of a legal framework, nurses in Belgian hospitals regularly prescribe medications. Most healthcare providers positively perceive the expected impact of nurse prescribing.
There is an urgent need for legal and institutional frameworks that acknowledge existing practices, define responsibilities and support safe and effective care. Structured policies could improve interprofessional collaboration, clarify clinical accountability and ensure consistent training for nurse prescribers.
This study addressed the widespread but informal practice of nurse prescribing in the absence of legal regulation in Belgium. It found that a majority of healthcare providers observed nurse prescribing in clinical practice and preferred formalised prescribing models. These insights can support health authorities, healthcare decision-makers and educators in designing regulations, implementation strategies and curricula aligned with clinical practice.
The authors adhered to the STROBE reporting checklist for cross-sectional studies.
This study did not include patient or public involvement in its design, conduct, analysis or reporting.
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