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What factors influence patient autonomy in healthcare decision-making? A systematic review of studies from the Global South

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posted on 2025-06-05, 14:59 authored by Muhammad Umair Akhtar, Muhammad Esswan Bhatti, Salim FredericksSalim Fredericks

Background: The principle of respect for autonomy (PRA) is a central tenet of bioethics. In the quest for a global bioethics, it is pertinent to ask whether this principle can be applied as it is to cultures and societies that are devoid of the Western sociopolitical historical pressures that led to its emergence. Relational autonomists have argued for a more inclusive approach to patient autonomy which takes into account factors such as interdependency and social relations. However, at the outset of any relational approach, it is necessary to identify underlying factors that influence patient autonomy in non-Western cultures.

Objective: To conduct a review of the literature to uncover the mechanisms through which social, cultural, and religious factors influence and impact the application of the PRA in healthcare decision- making in nonWestern cultures and societies.

Methods: We conducted a systematic review through a comprehensive search of three major electronic databases of biomedical sciences. Returned citations were imported to Covidence, full texts were assessed for eligibility, included articles were thoroughly reviewed and data was synthesized. PRISMA guidelines were followed.

Results: Our search retrieved 590 non-duplicate results, 50 of which were included after screening and fulltext eligibility checks. The included studies were predominantly qualitative in nature, with few quantitative, mixed-methods, and review studies included. Our synthesis of data identified nine key factors that influenced patients’ autonomous decision-making through cultural, social, religious, or intersectional pathways.

Conclusion: Two main conclusions emerge from this review. Firstly, there is a notable dearth of bioethical research examining the influence of diverse factors on patients’ inclination towards different conceptions of autonomy. Secondly, the analysis of prevalent collectivist cultures and deference of autonomy adds value to the solution-oriented relational autonomy debate. This rises questions regarding how decision- making can be truly autonomous in the presence of such large-scale factors, warranting further attention.

History

Data Availability Statement

All data generated or analyzed during this study are included in this published article and its supplementary information files.

Comments

Akhtar MU, Bhatti ME, Fredericks S. What factors influence patient autonomy in healthcare decision-making? A systematic review of studies from the Global South. Nurs Ethics. Copyright © 2025 Sage Publications. https://doi.org/10.1177/09697330241272794

Published Citation

Akhtar MU, Bhatti ME, Fredericks S. What factors influence patient autonomy in healthcare decision-making? A systematic review of studies from the Global South. Nurs Ethics. 2025;32(3):875-891.

Publication Date

22 August 2024

PubMed ID

39175161

Department/Unit

  • RCSI Bahrain

Publisher

SAGE Publications

Version

  • Accepted Version (Postprint)