Perspectives of infectious disease specialists on shared decision-making for fever of unknown origin: a national survey in China

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Background This study aimed to investigate the attitudes of infectious disease specialists toward shared decision-making (SDM) and identify the perceived barriers to its implementation in the management of fever of unknown origin (FUO) in China. Methods A nationwide, cross-sectional, online survey was conducted in July 2025 among infectious disease specialists at Chinese general hospitals. Eligible participants were infectious disease specialists registered and working in Chinese general hospitals. Exclusion criteria were: (1) individuals without prior experience treating patients with FUO; (2) individuals practicing in other specialties; (3) individuals unable to complete the survey on digital devices; and (4) questionnaires completed in under 120 s. The 27-item questionnaire assessed: (1) attitudes and implementation tendencies regarding the six steps of SDM; (2) perceived barriers to SDM; and (3) perceived effectiveness using the 9-item Shared Decision-Making Questionnaire-Doctor version (SDM-Q-Doc). Data were analyzed using descriptive statistics, univariate tests, Random Forest model, Least Absolute Shrinkage and Selection Operator (LASSO) regression, and multivariate linear regression. Results Of the 429 responses received, 386 were eligible (67.4% females and 32.6% males). The mean age of participants was 41.42 years. Only 107 participants (27.7%) reported prior knowledge of SDM, and 33 (8.5%) had received formal training. Mean scores were 4.46/6 for attitudes, 3.52/9 for barriers, and 40.77/45 for perceived effectiveness. Higher perceived effectiveness scores were significantly associated with gender, managing≥10 FUO cases annually, frequent participation in multidisciplinary discussions, prior knowledge of SDM, and positive attitudes toward SDM. Primary barriers included unequal information between physicians and patients ( n = 256, 66.3%), patients’ limited knowledge ( n = 243, 63.0%), and insufficient technical support and training ( n = 242, 62.7%). Multivariate analysis identified “presenting options clearly,” “inviting patients to participate in SDM,” “facilitating deliberation and decision-making” and “gender” as independent predictors of perceived effectiveness. Conclusion Infectious disease specialists in China demonstrated positive attitudes toward SDM in FUO management, which correlate with higher perceived effectiveness. To promote consistent and high-quality SDM in complex diagnostic scenarios, interventions should focus on structured training programs and the integration of decision-support tools into continuing medical education.

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