Rheumatic diseases (RMDs) are a group of chronic disorders that primarily affect the musculoskeletal system but can also involve systemic manifestations, many of which may have an autoimmune origin.

Treatment options include traditional and modern agents and non-pharmacologic interventions.1 However, while advancements in treatment interventions are significant, they should not overshadow the recognition that patient-centered care is the best approach for patients with RMDs.2,3 Multiple models and frameworks have been developed for describing patient-centered care.4 In 2014, Sholl et al. described a model with four main principles that constituted essential prerequisite activities to implement patient-centered care in daily clinical practice. The authors highlighted patient involvement in shared decision-making (SDM) as an essential activity.5,6 SDM is the process in which patients and clinicians collaborate to develop a treatment plan that incorporates evidence-based information, clinician expertise, and patient preferences, values, and goals.7

SDM in rheumatology has been extensively studied primarily in the USA, Asia, and Europe, where research has demonstrated that SDM improves patient satisfaction, treatment adherence, and overall outcomes in conditions such as rheumatoid arthritis (RA).7 However, there is a notable research gap focusing on Latin America (LATAM), a region characterized by diverse healthcare systems, disparities in the rheumatology workforce distribution – particularly in rural areas – and significant variation in healthcare coverage across countries, ranging from 22% in Paraguay to 100% in Argentina, Brazil, and Cuba.8 These contextual factors may influence the implementation and perception of SDM differently than in other regions. Limited data from LATAM suggest potential challenges, including cultural factors and the organization of healthcare teams and systems, which could impact effective SDM engagement between patients and rheumatologists. Addressing this gap is crucial to tailoring SDM approaches that are culturally and systemically appropriate for LATAM populations, thereby ensuring equitable and patient-centered rheumatologic care.

With these points in mind, the study aimed to initially address the topic and investigate the perceptions of the SDM process implementation in daily practice among patients with RMDs and rheumatologists from LATAM.

After its initial description in 1972,10 the SDM process has evolved and become a cornerstone of the quality of medical care. It is now recognized as the first principle in creating a treatment plan, and its application is mandatory in most national and international disease-specific treatment guidelines.7 SDM has demonstrated benefits in patient and physician outcomes. However, for these benefits to be realized, both members of the patient–physician partnership must perceive that SDM is being implemented as part of routine clinical care.

This study involved rheumatologists and patients with different RMDs from 17 countries in LATAM. It contributes to our current knowledge by addressing the lack of research studies conducted in the region,11,12 and the scarcity of studies that included patients with RMDs other than RA.11 We observed a significant difference in how rheumatologists and patients with RMDs perceive the implementation of SDM, with rheumatologists perceiving better engagement than the patients. This difference was less evident in the “sharing with the patient the different options for treating the condition” statement. Surprisingly, almost 97% of the physicians reported SDM implementation, and based on their responses, it may reveal that physicians misconceive the whole process. Results of a cross-sectional, exploratory, online survey completed by 147 healthcare professionals from the Netherlands (87% were rheumatologists) confirmed that healthcare professionals lacked a complete conceptual understanding of SDM.13 The findings of a qualitative systematic review highlight consistent results in tertiary care14; the review emphasizes that many clinicians lack formal training in SDM and communication, leading to uncertainty about whether they are applying SDM correctly.14 Our results might also reveal a physician paternalistic approach to the SDM process, confirmed among rheumatologists (and patients with RMDs) in Mexico.15 Meanwhile, the significant gap in the SDM implementation observed among the patients (compared to the physicians), despite similarly perceiving the step of “sharing the treatment options,” might reflect the complexity of the process from the patient's point of view, which depends on many factors at the levels of the patient, the physician, the healthcare team, and the healthcare system organization.16,17

Several limitations need to be taken into account. First, the sample size and geographic distribution across LATAM were uneven, with a predominance of patients from Mexico (42%) and Colombia (12%), and rheumatologists mainly from Colombia (53%) and Chile (24%). This disproportion may limit the generalizability of the findings to the entire region, which is characterized by significant heterogeneity in healthcare coverage, access, and cultural factors influencing SDM.8 Such imbalance can skew the results and hinder understanding of country-specific differences in SDM implementation. Future studies should aim to recruit larger and more representative samples evenly distributed across Latin-American countries or apply appropriate statistical adjustments to mitigate this bias.

Second, the potential impact of social desirability bias must be considered, especially among rheumatologists, who may have over-reported their involvement in SDM processes to align with perceived expected behaviors. This bias likely contributes to the notably higher proportion of physicians (approximately 97%) reporting SDM implementation compared to 62% of patients who perceived it. The discrepancy may also reflect physicians’ incomplete understanding of the SDM concept.13 To address this bias, future research should incorporate strategies such as ensuring anonymity, using indirect questioning, and integrating qualitative assessments to obtain more accurate representations of SDM practices.

Moreover, patients and physicians did not evaluate the same medical encounters, which might have influenced the differences in their perceptions. Patients’ diagnoses were self-reported and not verified through medical charts, which is another limitation to consider.

In conclusion, while this study reveals significant discrepancies in the perceived implementation of SDM between rheumatologists and patients with RMDs in LATAM, these findings should be interpreted carefully given the methodological limitations. Addressing these issues in future research will be critical to capture the complexities of the SDM process better and ultimately improve patient-centered care in the diverse healthcare settings of Latin America.

The results emphasize the need to educate patients and physicians about the SDM process so that the gap highlighted in the current study results can be acknowledged and reduced.

ALVG: methodology and supervision of the study, acquisition, analysis and interpretation of data, writing and review of the draft; MRE: acquisition, analysis and interpretation of data; AAC: acquisition, analysis and interpretation of data; GSOG: acquisition, analysis and interpretation of data; LLW: acquisition, analysis and interpretation of data; GAQ: acquisition, analysis and interpretation of data; VPR: conceptualization, visualization, design, methodology and supervision of the study, acquisition, analysis and interpretation of data, writing and review of the draft. All authors read and approved the final manuscript.

The study was approved by the Research Ethics Committee of Hospital San Vicente Fundación in Medellín (Colombia). The Committee waived the written or verbal informed consent requirement. It was assumed that explicit consent was given upon completion of the survey.

Not applicable.

The authors did not receive any funding.

The authors declare that they have no competing interests.

All data generated and analyzed during the development of this research are available upon request to the corresponding author.