Wednesday, 20 August 2025
A new study has revealed that cultural background can influence how mental healthcare staff approach shared decision making with patients.
Experts from the University of Nottingham’s Faculty of Medicine and Health Sciences revealed that culture shapes shared decision-making in mental healthcare. Psychiatrists in more individualistic and enjoyment-oriented cultures preferring it, whilst those in more hierarchical cultures tend not to. Their findings have been published in European Psychiatry.
Shared decision-making (SDM) is when healthcare staff and patients work together to choose the best treatment, based on medical evidence and what matters most to the patient. In mental health, SDM can improve quality of life, reduce hospital admissions, and support patient rights. However, the way healthcare staff approach SDM can vary between countries.
The researchers surveyed 751 psychiatrists and psychiatry trainees from 38 European countries to find out how much they prefer involving patients in decisions. Their answers were compared with cultural values from each country, using a well-known model of national culture (Hofstede’s six cultural dimensions).
The study revealed that psychiatrists in countries that value individual choice (high Individualism) and enjoyment/freedom (high indulgence) were more likely to prefer SDM. In contrast, those in countries where hierarchy is strongly accepted (high power distance) were less likely to prefer SDM. These trends suggest that cultural background can influence how healthcare staff approach decision-making with patients.
This study shows how influential culture can be in healthcare decision-making. It is also a complex and nuanced area too as when we took into account other factors (such as how healthcare systems are organised and how staff are trained), these cultural differences became less important.
He continues: "This means that while culture shapes attitudes, practical issues like time with patients and healthcare policy may have a bigger impact on whether SDM happens in practice.
Overall these findings highlight the need for SDM training and policies that are sensitive to local culture as well as healthcare structures. By understanding both, we can better support collaborative, respectful mental healthcare across different countries.”
Story credits
More information is available from Dr Yasuhiro Kotera on Yasuhiro.kotera@nottingham.ac.uk
Notes to editors:
About the University of Nottingham
Ranked 97 in the world and 17th in the UK by the QS World University Rankings, the University of Nottingham is a founding member of Russell Group of research-intensive universities. Studying at the University of Nottingham is a life-changing experience, and we pride ourselves on unlocking the potential of our students. We have a pioneering spirit, expressed in the vision of our founder Sir Jesse Boot, which has seen us lead the way in establishing campuses in China and Malaysia - part of a globally connected network of education, research and industrial engagement.
Nottingham was crowned Sports University of the Year by The Times and Sunday Times Good University Guide 2024 – the third time it has been given the honour since 2018 – and by the Daily Mail University Guide 2024.
The university is among the best universities in the UK for the strength of our research, positioned seventh for research power in the UK according to REF 2021. The birthplace of discoveries such as MRI and ibuprofen, our innovations transform lives and tackle global problems such as sustainable food supplies, ending modern slavery, developing greener transport, and reducing reliance on fossil fuels.
The university is a major employer and industry partner - locally and globally - and our graduates are the third most targeted by the UK's top employers, according to The Graduate Market in 2024 report by High Fliers Research.
We lead the Universities for Nottingham initiative, in partnership with Nottingham Trent University, a pioneering collaboration between the city’s two world-class institutions to improve levels of prosperity, opportunity, sustainability, health and wellbeing for residents in the city and region we are proud to call home.
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