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Patients’ perspective on shared decision-making in urology: a prospective study at a university hospital

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This study aims to determine the degree of shared decision-making (SDM) from urological patients’ perspective and to identify possible predictors.


Overall, 469 urological patients of a university outpatient clinic were recruited for this prospective study. Before a medical consultation, clinical and sociodemographic information, and patients’ emotional distress were assessed by questionnaires. After the consultation, patients completed the SDM-Questionnaire-9 (SDM-Q-9). The SDM-Q-9 scores of relevant subgroups were compared. Logistic regression was used to identify patients at risk for experiencing low involvement (SDM-Q-9 total score ≤ 66) in SDM.


Data from 372 patients were available for statistical analyses. The SDM-Q-9 mean total score was 77.8 ± 20.6. The majority of patients (n = 271, 73%) experienced a high degree of involvement (SDM-Q-9 total score > 66). The mean score per SDM-Q-9 item was in the upper range (3.9 ± 1.4 out of 5). The most poorly rated item was “My doctor wanted to know how I want to be involved in decision-making” (3.5 ± 1.6). Immigration status (OR 3.7, p = 0.049), and nonscheduled hospital registration (OR 2.1, p = 0.047) were significant predictors for less perceived involvement. Comorbidity, oncological status, and emotional distress did not significantly predict perceived participation.


In a university hospital setting, most urological patients feel adequately involved in SDM. Nevertheless, urologists should routinely ask for patients’ participation preference. Patients without a scheduled appointment and patients who immigrated may need more support to feel involved in SDM.

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Data availability

Please contact Britta Grüne for inquiries about access to (specified) data.


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Funding for this work was received by the German Cancer Aid (Deutsche Krebshilfe) funding program patient orientation (Grant number: 7011323).

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Authors and Affiliations



BG: data collection, data analysis, manuscript writing. AKK: project development, data management, manuscript editing. BB: project development, data management, manuscript editing. MSM: acquisition of funding, project development, supervision, manuscript editing. MCK: acquisition of funding, project development, data collection, supervision, manuscript editing. GWA: acquisition of funding, project development, supervision, manuscript editing.

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Correspondence to Britta Grüne.

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The authors have no conflict of interest.

Ethical approval

Ethical approval was obtained (institutional review board approval MA-2019-635 N, Ethics committee of the Medical Faculty of Mannheim, University of Heidelberg).

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All procedures were in accordance with the ethical standards of the institutional research committee and with the Helsinki Declaration and its later amendments or comparable ethical standards. Before participation, written informed consent was obtained from each patient.

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All authors made substantial contributions to the conception or design of this work. All authors drafted the work or revised it critically for important intellectual content. All authors approved the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Grüne, B., Köther, A.K., Büdenbender, B. et al. Patients’ perspective on shared decision-making in urology: a prospective study at a university hospital. World J Urol 39, 4491–4498 (2021).

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