How soundscape shapes restorative experience in a world heritage site: The mediating role of cultural authenticity at Mount Emei, China.

Shared decision-making (SDM) is a process that promotes patients’ involvement in their own care by respecting and responding to their individual preferences, needs, and values [,]. It is endorsed by professional bodies in Canada such as the Royal College of Physicians and Surgeons of Canada, which identifies SDM as a core competency in their Physician Competency Framework. Key competencies for SDM include establishing therapeutic relationships with patients, eliciting relevant information from patients, incorporating their perspectives, sharing healthcare information and plans, and engaging patients and their families in developing plans that reflect the patient’s healthcare needs and goals []. Central to SDM is the therapeutic relationship, which creates an environment where patients feel respected, listened to, and valued [–]. This relationship can be described as a partnership, or bond, between the provider and patient, composed of two elements: “caring” and “sharing” [–]. Research shows that a strong therapeutic relationship based on “caring” and “sharing” can enhance healthcare outcomes, including increased patient and provider satisfaction and improved quality of life [–]. “Caring” is characterized by trust, positive rapport building, empathy, and connection [,–], while “sharing” reflects key competencies of SDM [], where providers and patients jointly set goals and action plans based on the patient’s priorities and agree on respective roles within the relationship [–]. This then enables the provider and patient to reach an agreement and shared understanding, or common ground, regarding the patient’s healthcare. Reports published since the Institute of Medicine’s recommendation in the early 2000s indicate that most patients prefer sharing decisions with their providers []. However, these reports may not reflect the perspectives of immigrant patients, who remain underrepresented in the SDM literature []. Immigrant patients often have cultural [,] and linguistic [,,] differences from their providers, which may shape preferences and experiences distinct from those of native-born patients. For example, there are conflicting reports regarding the preferences of East Asian (Chinese, Japanese, Korean) immigrant patients in participating in SDM and engaging in the therapeutic relationship to establish mutual understanding. While some studies report that East Asian patients prefer to defer decision-making to their providers in their therapeutic relationships [–], others report preference for a more active approach to participating in decision-making [–]. Many East Asians come from cultures that value hierarchy and respect authority, which may lead patients to prefer a more passive role in the therapeutic relationship and decision-making. When physicians offer options and choices, it may be perceived by East Asian immigrant patients as indicating a lack of expertise and authority [,]. Conversely, patients who are more acculturated may prefer to engage more actively in the therapeutic relationship []. Even among those favoring a passive role, many still wish to receive sufficient information and establish mutual understanding with their providers [,,]. Misinterpretation by providers can further complicate SDM; assumptions that East Asian immigrants prefer passive roles in decision-making may stem from language barriers, patients’ difficulty articulating preferences, time constraints, or power imbalances in the patient-provider relationship [,]. Such miscommunication is not limited to East Asian populations. For example, one study of Arabic immigrant patients found that some believed “involvement” in decisions meant making healthcare decisions entirely on their own without provider input [,].