Effect of Regional COVID-19 Lockdowns on Alcohol Use and Smoking in Two Chilean University Communities: A Difference-In-Difference Analysis.

Shared decision-making (SDM) is a collaborative approach in which clinicians and the patient make health care decisions together, allowing the integration of the best available evidence with the patient’s values and preferences (). This approach marks a shift from the traditional paternalistic model, in which clinicians primarily direct decision-making, to a partnership model, in which patients are empowered as active decision-makers (). SDM has gained recognition as the preferred framework for patient-centered care, with research linking it to higher decision quality, greater patient satisfaction, and better care experiences (). In clinical practice, nurses have traditionally served as communicators and educators rather than active participants in patient decision-making processes. Nevertheless, nurses play a pivotal role in the SDM process as front-line communicators who translate complex medical information into understandable language, advocate for patient concerns, and offer continual support (). In addition, their extended interaction with patients and their families leads to close relationships and positions them as trusted health care providers. This trust enables nurses to elicit patients’ values and preferences and advocate for these preferences within the interdisciplinary team (). highlighted the nurse–patient relationship as the key channel for SDM, noting that effective communication and trust facilitate patient involvement in decisions regarding the timing of home visits and care related to activities of daily living. Through SDM, nurses not only align care with patient preferences but also gain greater control over their practice, improve their job satisfaction, and contribute to better care outcomes at the organizational level (). Despite the critical role that nurses play in SDM, their involvement in real-world SDM processes remains limited. SDM-related responsibilities are still often placed primarily on physicians, with the contributions to SDM of nurses frequently undervalued (). This limited engagement stems from not only individual factors but also broader social and organizational challenges. Systemic challenges commonly cited include time constraints and heavy workloads, which restrict opportunities for the in-depth communication required for SDM to succeed (; ). Role ambiguity and hierarchical team structures further inhibit engagement, as nurses may perceive treatment decision-making as being outside their professional scope or fear overstepping traditional boundaries in the physician-led decision-making process. Furthermore, lack of formal SDM training and limited exposure to tools such as decision aids hinder the readiness of nurses to participate effectively (; ). Moreover, workplace cultural factors and an unsupportive organizational environment may further decrease the willingness of nurses to collaborate with patients through SDM. These barriers contribute to inconsistent and often inadequate nurse participation in SDM.