赋能选择：医疗保健专业人员对肾癌共享决策的见解

Objective: To explore the perspectives of healthcare professionals (HCPs) on what enables or hinders shared decision-making (SDM) in everyday small renal masses (SRM) management. Subjects and methods: A systematic literature search was conducted, which informed a structured discussion guide. Subsequently, qualitative research was undertaken with HCPs involved in the management of SRM across the Netherlands, Germany, and the UK. Results: In total, 30 HCPs participated in the study, comprising semi-structured interviews and a focus group (the Netherlands 10 HCPs; Germany 11; UK nine). While SDM was consistently viewed as important and the concept could be explained, actual implementation varied substantially across countries. In the UK and the Netherlands, patients were typically offered, and HCPs discussed all major treatment options supported by nurse involvement. In Germany, SDM was often constrained: not all major treatment options were always presented, often influenced by resource limitations and financial incentives favouring surgery. Across all countries, key barriers to SDM included clinician bias, variable patient engagement, and time constraints. Facilitators to SDM were highlighted to be clear communication, visual aids, and audio-recording consultations. Conclusions: Shared decision-making is widely valued but inconsistently delivered and is heavily shaped by national structures. Tackling the identified barriers and leveraging known facilitators are key to making SDM a reality in SRM care.