Shared decision-making linked to higher satisfaction in Makkah primary care

Adults who reported greater involvement in shared decision-making at primary healthcare centers in Makkah City also reported higher overall satisfaction with care, according to a multicenter cross-sectional study conducted in 2025. Across eight participating centers, each 10-point increase on the 0–100 Shared Decision-Making Questionnaire was associated with an adjusted 0.91-point increase on the 18–90 Patient Satisfaction Questionnaire Short Form. The association was statistically significant but modest, and the study does not establish that shared decision-making caused greater satisfaction.

The analysis included 407 eligible adults from 413 completed questionnaires. Participants had a mean age of 32.1 years, with a standard deviation of 11.7, and 72.2% were female. Most were Saudi nationals, permanent residents of Makkah, urban residents, and educated to university or postgraduate level. Eight primary healthcare centers were selected through stratified random sampling across the city’s four geographical sectors, while individual patients were recruited by convenience sampling from waiting areas. Consequently, the results describe the participating primary-care population but are not population-representative estimates for all Makkah residents.

Researchers measured perceived shared decision-making with the validated nine-item SDM-Q-9, whose raw total of 0–45 was transformed to a 0–100 scale. Each item used a six-point response ranging from complete disagreement to complete agreement, with higher transformed scores indicating greater perceived involvement. The mean score was 53.99, with a standard deviation of 33.03 and a median of 55.56, suggesting moderate involvement overall but substantial variation between patients. Internal consistency was high for the questionnaire, with Cronbach’s alpha of 0.970.

Patient satisfaction was assessed with the validated Arabic version of the 18-item PSQ-18, covering general satisfaction, technical quality, interpersonal manner, communication, financial aspects, time spent with the doctor, and accessibility or convenience. Negatively worded items were reverse-scored so that higher totals consistently represented greater satisfaction. The mean total was 59.20 out of 90, with a standard deviation of 9.57. Communication received the highest mean domain score at 3.59, followed by general satisfaction at 3.56, while time spent with the doctor scored lowest at 2.94.

Before adjustment, shared decision-making and satisfaction had a weak positive rank correlation, with Spearman’s rho equal to 0.258 and P below 0.001. The researchers then used multivariable linear regression to account for age, sex, nationality, residency status in Makkah, area of residence, marital status, educational attainment, and frequency of healthcare visits. Because the regression diagnostics detected heteroscedasticity, the primary analysis used HC3 heteroscedasticity-consistent standard errors. In this model, a 10-point increase in SDM-Q-9 was associated with a 0.91-point higher PSQ-18 score, with a 95% confidence interval of 0.58–1.23 and P below 0.001.

The result remained similar under several alternative analyses. Conventional multivariable linear regression produced the same point estimate of 0.91, with a 95% confidence interval of 0.63–1.19. Adding the primary healthcare center as a fixed effect yielded a slightly smaller association of 0.86, with a 95% confidence interval of 0.52–1.21. Median quantile regression gave an estimate of 0.87, with a 95% confidence interval of 0.41–1.33. All three adjusted estimates had P values below 0.001, indicating that the direction and magnitude of the association were not materially altered by these analytical choices.

Secondary analyses examined whether shared decision-making scores were related to individual satisfaction domains. After adjustment for the same participant-level variables, a 10-point increase in SDM-Q-9 was associated with higher scores for general satisfaction, technical quality, communication, financial aspects, time spent with the doctor, and accessibility or convenience. The largest domain estimate was for communication, at 0.08 points per 10-point increase, followed by 0.07 for general satisfaction and 0.06 for technical quality. All six associations remained statistically significant after Benjamini–Hochberg false-discovery-rate correction. The association with interpersonal manner was not statistically significant, with an estimate of 0.01 and P of 0.212.

The item-level responses offered a more mixed picture of how shared decision-making unfolds in routine care. Patients were comparatively more likely to agree that their doctor helped them understand information, whereas active joint evaluation of treatment alternatives was less consistently reported. This distinction matters because shared decision-making involves more than information delivery: it includes exchanging information, discussing alternatives, considering patient preferences, and reaching a decision jointly. Favorable experiences were also evident in other parts of the survey, including explanations of medical tests and friendly treatment by doctors. At the same time, 27.5% strongly agreed that arranging an appointment was difficult, and 24.8% strongly agreed that emergency treatment required excessive waiting.

Exploratory analysis identified three participant characteristics associated with perceived shared decision-making, but the evidence for these subgroup patterns was less secure. Rural participants had scores about 13.09 points higher than urban residents, with a 95% confidence interval of 3.67–22.51 and P of 0.007. Saudi participants scored 8.41 points lower than non-Saudi participants, while single participants scored 9.04 points lower than married participants. Age, residency status, widowed or divorced status, education, and visit frequency were not significantly associated with SDM-Q-9 scores. The rural and non-Saudi subgroups contained only 37 and 48 participants, respectively, so these findings should be treated as hypothesis-generating rather than evidence of a durable demographic pattern.

Several limitations constrain how the findings can be interpreted. The cross-sectional design measured both shared decision-making and satisfaction during the same period, preventing the researchers from establishing temporal order or causality. Reverse causality is possible: patients satisfied with an encounter may also be more inclined to perceive or report greater involvement. The survey did not collect potentially important clinical or encounter-level factors, including illness severity, consultation type and duration, continuity with the physician, physician characteristics, and whether multiple reasonable treatment alternatives were available. Self-reporting may also have introduced recall, social-desirability, and common-method biases, while convenience recruitment and an unavailable systematic record of refusals left non-response bias unresolved.

Patient satisfaction is shaped by more than the decision-making conversation. The primary model explained 11.3% of the variation in PSQ-18 scores, with an adjusted R-squared of 8.6%, indicating that most differences remained unexplained. Access, waiting time, technical care, interpersonal conduct, continuity, and organizational factors may all contribute. The 0.91-point difference associated with a 10-point increase in SDM-Q-9 also cannot be assumed to be clinically important, because the study did not establish a minimal clinically important difference for the total PSQ-18 score. The findings therefore show a small, consistent association in a selected group of Makkah primary-care users, not proof that changing how decisions are made will automatically raise satisfaction. Prospective longitudinal and intervention studies would be needed to test that causal question.

Subject of Research: Association between perceived shared decision-making and patient satisfaction in Makkah primary healthcare

Article Title: Perceived shared decision-making (SDM) involvement and its association with patient satisfaction among primary healthcare visitors in Makkah city: a cross-sectional study

Article References: Alghamdi, A. A., & Alqurashi, J. H. (2026). Perceived shared decision-making (SDM) involvement and its association with patient satisfaction among primary healthcare visitors in Makkah city: a cross-sectional study. Frontiers in Medicine, 13, Article 1984378. https://doi.org/10.3389/fmed.2026.1984378

Image Credits: AI Generated

DOI: 10.3389/fmed.2026.1984378

Keywords: shared decision-making, patient satisfaction, primary healthcare, patient-centered care, Makkah, Saudi Arabia, cross-sectional study, healthcare communication, health services research, Perceived, shared, decision-making