Introduction Shared decision-making (SDM) is the gold standard of patient-clinician interaction, yet many patients are not active in medical consultations. Despite ongoing implementation efforts, the research on barriers to SDM within the patient-clinician relationship and interaction is scant. To identify potential barriers to uro(onco)logical patients‘ participation in decision-making, we developed two novel scales assessing power asymmetry (PA-ME) and embarrassment in medical encounters (EmMed). The present study validates both scales in a sample of uro(onco)logical patients and non-clinical participants. Further, it examines the effects of both factors on participation preferences and decisional conflict among uro(oco)logical patients.

Methods A total of 107 uro(onco)logical patients and 250 non-clinical individuals rated perceived power asymmetry in the patient-clinician relationship and general experiences of embarrassment in the medical context using the PA-ME and the EmMed. Further, uro(onco)logical patients indicated their participation preferences in decisions regarding general medical care and urological care in particular. After consultation with their clinician, they reported perceived decisional conflict.

Results Preliminary analyses yielded clear factor structures and good internal consistency for both questionnaires. In uro(onco)logical patients, more perceived power asymmetry predicted lower generic participation preference and higher decisional conflict. Embarrassment was not linked to generic participation preferences but positively predicted decisional conflict. Neither power asymmetry nor embarrassment were specifically associated with participation preferences regarding urological care.

Discussion Our findings emphasize power asymmetry and embarrassment as substantial barriers to SDM in uro(onco)logical patients. Given their promising psychometric properties, the introduced instruments are recommended for routine assessment of both barriers in the medical context.

Conclusion(s) Addressing power asymmetry and embarrassment among patients may alleviate their impact on participation in SDM, fostering more patient engagement in medical decisions.