Preferences and challenges regarding medical decision-making among patients with a migration background in Belgium: a focus group study

Abstract

Background: The growing cultural diversity in Belgium, with over one third of the population having a migration background, presents distinct challenges for primary healthcare, particularly in doctor-patient interactions. Medical decision-making (MDM) is at the core of clinical practice in primary healthcare. According to existing literature, MDM may be complicated not only by general challenges arising in intercultural health communication, but also by specific cultural preferences concerning patient autonomy. This study aims to examine preferences and challenges regarding MDM among patients with a migration background in Belgium, from the perspectives of patients and general practitioners (GPs). Methods: Data were collected through five focus group discussions (FGDs), organised in November and December 2023. Three FGDs involved patients from the major migrant population groups in Belgium (Moroccan (n = 6), Turkish (n = 6), and sub-Saharan African (n = 7), and two FGDs involved GPs (n = 13). The data were analysed through reflexive thematic analysis. Results: Our results show that preferences and challenges revolved around four key components of MDM: Exchange of medical information, decision-making agency, patient-provider relationship, and treatment plan. These preferences and challenges were shaped by a complex interplay of factors at the individual (e.g., patient education, provider attitudes), interpersonal (e.g., family dynamics, language barriers), institutional (e.g., legal framework, medical education), and cultural levels (e.g., religion, health beliefs). Conclusions: Our study highlights the importance of adopting an intersectional and multilayered perspective on MDM, which considers how various factors interact and shape preferences and challenges in MDM, depending on the individual and their context. Although it is impossible for GPs to be aware of every cultural preference, this study shows how GPs can engage in more culturally sensitive interactions with their patients. By also addressing the institutional factors that contribute to challenges in MDM, this approach can improve person-centred care by better accommodating each patient’s unique needs and preferences.