The place for people in rewilding.

Rewilding, although controversial, is increasingly presented as humanity's best hope of addressing the global biodiversity crisis, but it remains unclear how restoring nonhuman autonomy affects people's relationships with nature. We conceptualized 3 human-nature relationships (HNRs) that could occur when restoring nonhuman autonomy: human-nature dichotomy, human-nature compromise, and human-nature mutualism. Through 51 interviews, we then empirically tested the occurrence of these HNRs across diverse actors living and working in 2 longstanding British rewilding initiatives to better understand the place for people in rewilding. Actors' HNRs aligned with the 3 conceptual framings, but these relationships were complex. Individuals often demonstrated multiple perspectives that transcended conventional actor categorization. The tripartite framing also revealed conflicting values across and within individuals, resulting in pluralistic HNRs. Our work adds to the theory and practice surrounding the place for people in rewilding by cautioning against a single preferred HNR when restoring nonhuman autonomy and advocating that a diversity of human interactions with nature should be integrated into the global rewilding movement.

El lugar de las personas en la renaturalización Resumen Aunque la renaturalización es controversial, se presenta cada vez más como la mejor esperanza para que la humanidad aborde la crisis mundial de biodiversidad, aunque todavía no está claro el efecto de la restauración de la autonomía no humana sobre las relaciones entre las personas y la naturaleza. Conceptualizamos tres relaciones humanidad­naturaleza (RHN) que podrían ocurrir al restaurar la autonomía no humana: dicotomía, equilibrio y mutualismo, todas entre los humanos y la naturaleza. Realizamos 51 entrevistas para probar de forma empírica la ocurrencia de estas RHN con varios actores que viven y trabajan dentro de las dos iniciativas británicas de renaturalización más antiguas y así entender mejor el lugar de las personas en la renaturalización. Las HNR de los actores se alinearon con los tres marcos conceptuales, aunque estas relaciones fueron complejas. Los individuos frecuentemente mostraron tener varias perspectivas que trascendían la categoría de los actores. El marco tripartito también reveló valores conflictivos entre y en los individuos, lo que resultó en RHN pluralistas. Nuestro trabajo suma a la teoría y práctica en torno al lugar de la gente en la renaturalización con la prevención de una sola relación humanidad­naturaleza preferida cuando se restaura la autonomía no humana y con la recomendación de que la diversidad de interacciones humanas con la naturaleza debería integrarse al movimiento mundial de renaturalización.

AI as a user of AI: Towards responsible autonomy.

Recent advancements in Artificial Intelligence (AI), particularly in generative language models and algorithms, have led to significant impacts across diverse domains. AI capabilities to address prompts are growing beyond human capability but we expect AI to perform well also as a prompt engineer. Additionally, AI can serve as a guardian for ethical, security, and other predefined issues related to generated content. We postulate that enforcing dialogues among AI-as-prompt-engineer, AI-as-prompt-responder, and AI-as-Compliance-Guardian can lead to high-quality and responsible solutions. This paper introduces a novel AI collaboration paradigm emphasizing responsible autonomy, with implications for addressing real-world challenges. The paradigm of responsible AI-AI conversation establishes structured interaction patterns, guaranteeing decision-making autonomy. Key implications include enhanced understanding of AI dialogue flow, compliance with rules and regulations, and decision-making scenarios exemplifying responsible autonomy. Real-world applications envision AI systems autonomously addressing complex challenges. We have made preliminary testing of such a paradigm involving instances of ChatGPT autonomously playing various roles in a set of experimental AI-AI conversations and observed evident added value of such a framework.

Caesarean section on maternal request: a qualitative study of conflicts related to shared decision-making and person-centred care in Sweden.

BACKGROUND: Today, person-centred care is seen as a cornerstone of health policy and practice, but accommodating individual patient preferences can be challenging, for example involving caesarean section on maternal request (CSMR). The aim of this study was to explore Swedish health professionals' perspectives on CSMR and analyse them with regard to potential conflicts that may arise from person-centred care, specifically in relation to shared decision-making. METHODS: A qualitative study using both inductive and deductive content analysis was conducted based on semi-structured interviews. It was based on a purposeful sampling of 12 health professionals: seven obstetricians, three midwives and two neonatologists working at different hospitals in southern and central Sweden. The interviews were recorded either in a telephone call or in a video conference call, and audio files were deleted after transcription. RESULTS: In the interviews, twelve types of expressions (sub-categories) of five types of conflicts (categories) between shared decision-making and CSMR emerged. Most health professionals agreed in principle that women have the right to decide over their own body, but did not believe this included the right to choose surgery without medical indications (patient autonomy). The health professionals also expressed that they had to consider not only the woman's current preferences and health but also her future health, which could be negatively impacted by a CSMR (treatment quality and patient safety). Furthermore, the health professionals did not consider costs in the individual decision, but thought CSMR might lead to crowding-out effects (avoiding treatments that harm others). Although the health professionals emphasised that every CSMR request was addressed individually, they referred to different strategies for avoiding arbitrariness (equality and non-discrimination). Lastly, they described that CSMR entailed a multifaceted decision being individual yet collective, and the use of birth contracts in order to increase a woman's sense of security (an uncomplicated decision-making process). CONCLUSIONS: The complex landscape for handling CSMR in Sweden, arising from a restrictive approach centred on collective and standardised solutions alongside a simultaneous shift towards person-centred care and individual decision-making, was evident in the health professionals' reasoning. Although most health professionals emphasised that the mode of delivery is ultimately a professional decision, they still strived towards shared decision-making through information and support. Given the different views on CSMR, it is of utmost importance for healthcare professionals and women to reach a consensus on how to address this issue and to discuss what patient autonomy and shared decision-making mean in this specific context.

Person-centered care is today a widespread approach, but accommodating individual patient preferences can be challenging, for example involving caesarean section on maternal request (CSMR). This study examines Swedish health professionals' views on CSMR. Interviews with 12 health professionals reveal conflicts between CSMR and key aspects of person-centered care, in particular shared decision-making. While professionals acknowledge women's autonomy, they question CSMR without medical need. Concerns include for example treatment quality and patient safety, and avoiding treatments that harm others. The Swedish context, balancing collective solutions with individualized care, complicates decision-making. Unlike countries with more private healthcare, where CSMR support might be higher, Swedish health professionals emphasize shared decision-making despite viewing the mode of delivery as primarily a professional decision. This study sheds light on the challenges in integrating CSMR into person-centered care frameworks.

From self-commitment to career crafting: The mediating role of career adaptability and the moderating role of job autonomy.

The objective of this study is to explore the influence of self-commitment on career crafting, examining the mediating role of career adaptability and the moderating effect of job autonomy within the context of career construction theory. This research aims to deepens our understanding of the key mechanisms that underpin successful career development, providing valuable insights for both individuals and organizations to enhance career success and adaptability. Utilizing a two-wave survey methodology, we collected data from 363 full-time employees across various industries in the United States. Hierarchical regression analysis and the PROCESS Macro were employed to test the proposed hypotheses. Our findings reveal that self-commitment significantly enhances career crafting through career adaptability. Additionally, job autonomy was found to influence both the direct relationship between self-commitment and career adaptability, and the indirect relationship between self-commitment and career crafting. This study highlights the pathways linking self-commitment to career crafting, underscoring the importance of career adaptability as a developmental tool facilitated by job autonomy. We recommend that individuals commit to their personal growth to enhance their career adaptability and actively shape their careers. Meanwhile, organizations should focus on promoting job autonomy to foster career development, benefiting both employees and the broader organizational ecosystem.

The Wrong of Eugenic Sterilization.

I defend a novel account of the wrong of subjecting people to non-consensual sterilization (NCS), particularly in the context of the state-sponsored eugenics programmes once prevalent in the United States. What makes the eugenicist practice of NCS distinctively wrong, I claim, is its dehumanizing core: the fact that it is tantamount to treating people as nonhuman animals, thereby expressing the degrading social meaning that they have the value of animals. The practice of NCS is prima facie seriously wrong partly, but crucially, on these grounds. I consider and reject accounts of the wrong of NCS that make no reference to its animalizing character, such as that it violates victims' (procreative) autonomy, amounts to treating them merely as a means, inflicts psychological harm on them, or constitutes an affront to their human dignity. My discussion suggests that the critical vocabulary of bioethics should be expanded beyond talk of rights violations, benefits and harms, and equal treatment-and that the language of dehumanization is indispensable to bioethicists.

Lack of autonomy and professional recognition as major factors for burnout in midwives: A systematic mixed-method review.

AIM: The aim of this study was to review the existing evidence on burnout levels in midwives and the main related factors. DESIGN: Mixed studies systematic review. DATA SOURCES: PubMed, Scopus and Web of Science were sourced from 2018 and 2023. REVIEW METHODS: Inclusion criteria: quantitative cross-sectional or qualitative articles published in English within the last 5 years. EXCLUSION CRITERIA: studies with undergraduate or trainee midwives, studies examining the factors in a pandemic setting and those not answering the research question. Potential risk of bias was assessed using the Mixed Methods Assessment Tool (MMAT). A convergent synthesis design was followed through a thematic synthesis using Thomas and Harden's three-step method: inductive coding of the text, development of descriptive themes and generation of analytical themes. Qualitative approaches adopted exploratory descriptive studies and participatory action research. RESULTS: Thirty-six studies were included, with a total of 17,364 participants. There were higher levels of burnout in midwives who were single, under 35-40 years of age, with less than 10 years of experience and those with young children. Stress, anxiety and depression, as well as the emotional impact of traumatic events, have been described as related psychological factors. CONCLUSION: Although extrinsic work factors such as shifts, workload, pay and interpersonal relationships increase burnout, intrinsic factors such as lack of autonomy and recognition are the main factors related to it. IMPACT: What problem did the study address? Burnout among healthcare workers has been recognized as a global crisis requiring urgent attention, specifically in midwives. What were the main findings? There is a persistent shortage of midwives that is attributed in part to chronic retention difficulties related to job burnout expressed by these professionals. Where and on whom will the research have an impact? We seek to address the paucity of research on burnout in midwives in the current crisis in the profession. Work factors such as lack of autonomy or recognition in the profession carry an associated risk of burnout and job attrition. Understanding the factors that contribute to burnout will enable healthcare organizations to reduce the current problem. REPORTING METHOD: PREFERRED: Reporting items for systematic review and meta-analyses (PRISMA). PATIENT OF PUBLIC CONTRIBUTION: No patient or public contribution.

Bridging the Gap: A Qualitative Assessment of General Surgery Resident Confidence and Knowledge Deficits in Managing Surgical Endocrinopathy.

BACKGROUND: Most thyroid and parathyroid surgeries are performed by nonfellowship trained, low-volume surgeons with associated higher complication rates. Furthermore, the average number of endocrine procedures performed by general surgery residents is decreasing. While previous studies have documented a lack of general surgery resident confidence in performing these procedures, the specific knowledge gaps in endocrine surgery remain unexplored. METHODS: We conducted semi-structured interviews with surgical residents (clinical PGY3-PGY5) at a high-volume academic center with an endocrine surgery fellowship to discuss their experience, knowledge, and deficits managing patients with surgical thyroid and parathyroid disease. Interviews were audio-recorded, de-identified, and transcribed verbatim. Content analysis was used to identify areas of confidence and knowledge deficits in all phases of care. RESULTS: Overall, 14 trainees participated in the study (50% women, mean PGY: 3.8). Preoperatively, residents were confident with thyroid nodule and primary hyperparathyroidism work-up, but less comfortable with rare conditions. Residents were uncomfortable using ultrasound to identify suspicious lymph nodes or abnormal parathyroid glands. Residents perceived knowledge deficits in the multidisciplinary care and work-up of patients with advanced thyroid cancer. Intraoperatively, most residents were confident performing thyroidectomy and focused parathyroidectomy, but less comfortable performing 4-gland explorations or neck dissections. Several had concern with independently identifying and protecting the recurrent laryngeal nerve or locating parathyroid glands in the setting of negative localization. Residents noted a lack of autonomy in both thyroidectomy and parathyroidectomy. Postoperatively, residents felt confident in the acute management of patients, but identified deficits in long-term management of patients with thyroid cancer or chronic complications. CONCLUSIONS: Despite confidence in managing "bread and butter" cervical endocrine surgery in all phases of care, residents perceive a lack of meaningful autonomy intraoperatively. Further educational endeavors may be required to ensure graduating residents are "practice ready" for straightforward cases they may encounter in practice as a general surgeon. A lack of exposure to complex endocrinopathy even at a high-volume center suggests that comprehensive endocrine surgery fellowship remains critical.

Validation of the Greek version of Mother's Autonomy in Decision Making (MADM) scale.

INTRODUCTION: Ensuring expectant mothers have the capacity to make well-informed decisions regarding their prenatal care, encompassing medical interventions, and birthing preferences are crucial for fostering favorable health outcomes for both mother and newborn. The Mother's Autonomy in Decision Making (MADM) scale serves as a commonly utilized tool for evaluating the autonomy of pregnant women in the decision-making processes related to prenatal care and childbirth. The aim of this study is to validate the MADM scale in women who had at least one home childbirth experience in Greece. METHODS: A retrospective online survey collected data from Greek women with home childbirth experience (January 2010 - December 2023). We utilized a self-administered questionnaire and the Greek version of the MADM scale. RESULTS: The study included 162 women, predominantly of Greek nationality (94.4%) and residing in Attica (54%). The MADM scale showed a median score of 38. The confirmatory factor analysis indicated acceptable fit and reliability (comparative fit index, CFI=0.92; Tucker-Lewis index, TLI=0.91; root mean square error of approximation, RMSEA=0.07; Cronbach's α=0.92). Age correlated weakly negatively with the MADM scale score (Spearman's rho= -0.166, p=0.035). Additionally, women attending antenatal preparation courses with a midwife before their first home birth had higher MADM scores (median 39 vs 35, p=0.037). CONCLUSIONS: The study underscores the importance of the MADM scale, demonstrating its reliability and validity for women living in Greece. Younger age and attending antenatal preparation courses with a midwife were associated with higher MADM scores, highlighting education's role in maternal autonomy.

Measurement of basic psychological needs for physical activity participation for college students with intellectual disabilities: A validation study.

BACKGROUND: Measurement instruments to understand self-determined motivation towards physical activity among college students with intellectual disabilities are needed to develop programs to support physical and psychological health and well-being. The purpose of the current study was to validate a modified questionnaire measuring basic psychological needs towards physical activity among college students with intellectual disabilities. METHODS: A total of 108 college students with intellectual disabilities completed the modified questionnaire. Validity and reliability of the questionnaire was examined. RESULTS: Confirmatory factor analysis demonstrated a six-factor model had good model fit. Cronbach's alpha values showed acceptable reliability evidence of the instrument as a whole, although some alpha values in subdomains of the instrument were below acceptable values. CONCLUSION: The modified questionnaire was found to have acceptable validity evidence. Further studies are needed with refinement of answer options and the addition of more questions to increase reliability.

Psychodynamic psychotherapy for gender dysphoria is not conversion therapy.

Over the last ten years, there has been a substantial increase in the number of children and adolescents referred to gender clinics for possible gender dysphoria. The gender affirming model of care, a dominant treatment approach in Canada, is based on low quality evidence. Other countries are realizing this and making psychosocial treatments and/or exploratory psychotherapy a first line of treatment for gender related distress in young patients. Psychodynamic (exploratory) psychotherapy has established efficacy for a range of conditions, and has been used in youth and adults with gender dysphoria. In Canada, the adoption of psychodynamic psychotherapy for gender dysphoria is impeded by some academics who argue that it may violate laws against conversion therapy. Psychodynamic psychotherapy is not conversion therapy and should be made available in Canada as a treatment modality for gender dysphoria.

Open optimism as an "embodied-health" ethic for the information era.

This article forms part of a series on "openness," "non-linearity," and "embodied-health" in the post-physical, informational (virtual) era of society. This is vital given that the threats posed by advances in artificial intelligence call for a holistic, embodied approach. Typically, health is separated into different categories, for example, (psycho)mental health, biological/bodily health, genetic health, environmental health, or reproductive health. However, this separation only serves to undermine health; there can be no separation of health into subgroups (psychosomatics, for example). Embodied health contains no false divisions and relies on "optimism" as the key framing value. Optimism is only achieved through the mechanism/enabling condition of openness. Openness is vital to secure the embodied health for individuals and societies. Optimism demands that persons become active participants within their own lives and are not mere blank slates, painted in the colors of physical determinism (thus a move away from nihilism-which is the annihilation of freedom/autonomy/quality). To build an account of embodied health, the following themes/aims are analyzed, built, and validated: (1) a modern re-interpretation and validation of German idealism (the crux of many legal-ethical systems) and Freud; (2) ascertaining the bounded rationality and conceptual semantics of openness (which underlies thermodynamics, psychosocial relations, individual autonomy, ethics, and as being a central constitutional governmental value for many regulatory systems); (3) the link between openness and societal/individual embodied health, freedom, and autonomy; (4) securing the role of individualism/subjectivity in constituting openness; (5) the vital role of nonlinear dynamics in securing optimism and embodied health; (6) validation of arguments using the methodological scientific value of invariance (generalization value) by drawing evidence from (i) information and computer sciences, (ii) quantum theory, and (iii) bio-genetic evolutionary evidence; and (7) a validation and promotion of the inalienable role of theoretic philosophy in constituting embodied health, and how modern society denigrates embodied health, by misconstruing and undermining theoretics. Thus, this paper provides and defends an up-to-date non-physical account of embodied health by creating a psycho-physical-biological-computational-philosophical construction. Thus, this paper also brings invaluable coherence to legal and ethical debates on points of technicality from the empirical sciences, demonstrating that each field is saying the same thing.

Learning from disability studies to introduce the role of the individual to naturalistic accounts of disease.

Disability studies have been successfully focusing on individuals' lived experiences, the personalization of goals, and the constitution of the individual in defining disease and restructuring public understandings of disability. Although they had a strong influence in the policy making and medical modeling of disease, their framework has not been translated to traditional naturalistic accounts of disease. I will argue that, using new developments in evolutionary biology (Extended Evolutionary Synthesis [EES] about questions of proper function) and behavioral ecology (Niche conformance and construction about the questions of reference classes in biostatistics accounts), the main elements of the framework of disability studies can be used to represent life histories at the conceptual level of the two main "non-normative" accounts of disease. I chose these accounts since they are related to medicine in a more descriptive way. The success of the practical aspects of disability studies this way will be communicated without causing injustice to the individual since they will represent the individuality of the patient in two main naturalistic accounts of disease: the biostatistical account and the evolutionary functional account. Although most accounts criticizing the concept of disease as value-laden do not supply a positive element, disability studies can supply a good point for descriptive extension of the concept through inclusion of epistemic agency.

Work autonomy and its associated factors among health professionals in public hospitals of North East Ethiopia.

A low level of work autonomy is the bottleneck for the health service delivery and the quality of the service. Although work autonomy is the pillar of organizational commitment and a means of employee retention mechanism, information about the magnitude of work autonomy among health professionals is limited in Ethiopia. Therefore, this study aimed to assess work autonomy and its predictors among health professionals working in public hospitals of Northeast Ethiopia. Institution-based cross-sectional study was conducted from March 24 to April 24, 2021, among health professionals using a stratified sampling technique. Variables with a p-value of < 0.25 in bivariable analysis were included in the multivariable analysis and variables with a p-value of < 0.05 in multivariable analysis were regarded as significantly associated factors. The overall good work autonomy in public hospitals (Dessie and Boru Meda Hospital) of North East Ethiopia was 54.5% (95% CI 54.48-54.53). Satisfaction with organizational policy and strategy (AOR 2.34, 95% CI 1.29-4.25), satisfaction with supervisor support (AOR 7.20, 95% CI 3.97-13.07), good health service delivery planning practice (AOR 1.88, 95%CI: 1.13-3.13), being married (AOR 4.26, 95%CI: 2.06-8.82) being pharmacy professionals (AOR 0.44, 95% CI 0.19-0.98), and being anesthesia and radiology professionals (AOR 4.66, 95% CI 1.65-13.19) were significantly associated with work autonomy of health professionals. More than half of the health professionals working in public hospitals in Northeast Ethiopia are autonomous in their work. Satisfaction with organizational policy and strategy, satisfaction with supervisor support, having good health service delivery planning practice, being married, and type of profession were significantly associated factors in public hospitals. Thus, strengthening strategies aimed at shaping poor health service delivery planning practices and dissatisfaction of employees concerning supervisor support and organizational policy might have a substantial contribution to improving the work autonomy of health professionals.

Corrigendum: Are face transplant candidates choosing autonomously? A preliminary method to evaluate autonomous choosing in psychosocial and bioethical assessments.

[This corrects the article DOI: 10.3389/frtra.2024.1346667.].

Are face transplant candidates choosing autonomously? A preliminary method to evaluate autonomous choosing in psychosocial and bioethical assessments.

This report proposes a framework for evaluating the validity of informed consent and autonomy in face transplant candidates, taking into account the risk of depression and non-compliance. Traditional factors like decisional capacity, disclosure, comprehension, voluntariness, and agreement are insufficient for assessing valid informed consent in individuals whose self-worth relies on public perception, potentially leading to self-harm if societal worth is undermined. Reliance on self-esteem, rather than inherent personal value, poses risks of depression, poor treatment adherence, and deferential vulnerability. We suggest a qualitative analysis of self-worth, self-esteem, self-trust, and self-respect to better assess the autonomy of face transplant candidates in their decision-making process.

How does perceived overqualification promote employees' creative deviance: The role of leadership emergence and job autonomy.

Inspiring the creative potential of overqualified employees can facilitate a mutually beneficial outcome for both the company and the employees. However, further investigation is required to ascertain how to stimulate the perceived overqualification of employees to carry out creative deviance. Drawing upon role theory, this study explores the impact mechanism of perceived overqualification on employee creative deviance, with leadership emergence as the mediating variable, and further examines the moderating role of job autonomy. Adopting a two-stage design, 362 valid data samples were collected from various companies, and analysis was conducted using partial least squares structural equation modeling. The results indicate a positive correlation between perceived overqualification and creative deviance. Perceived overqualification not only positively influences leadership emergence but it also indirectly affects creative deviance through leadership emergence. Furthermore, when individuals with perceived overqualification and possess a greater level of job autonomy, they are more likely to engage in creative deviant behavior. The findings contribute to understanding the mediating mechanisms and boundary conditions of employees' perceived overqualification influencing creative deviance from a positive perspective, offering valuable managerial insights for organizations.

Ethical Issues of Medical Schools and their Academic Departments Accepting Gifts from Pharma.

The ethical implications of medical schools or any of their academic departments accepting large corporate donations, mainly from pharmaceutical companies, have been long debated. While such contributions are common in other graduate institutions, medical schools must be convinced about potential conflicts of interest and public opinion. We re-explore the benefits these kinds of gifts would afford for improved educational and research resources against the ethical dilemmas this kind of donation would present and concerns about public perception and actual conflict of interest. Utilizing the principles of beneficence, non-maleficence, autonomy, and distributive justice, we discuss the physicians' obligations and conceivable patient backlash that may ensue. Ultimately, we recognize the necessity for financial resources to support academic missions but contend that healthcare facilities and medical education must be equipped to ensure a complete lack of bias in sponsorship.

Examination of learning ability development through the implementation of the "autonomy-collaboration" learning mode grounded in evidence-based medicine practice.

OBJECTIVE: Currently, there are still some shortcomings in EBM education in China.The study aimed to investigate the effectiveness of the novel evidence-based medicine (EBM) learning model of "autonomy-collaboration." METHODS: A total of 91 undergraduate students majoring in clinical medicine at Zhongshan Clinical College of Dalian University from the 2019 batch were selected as the participants in this study. They were instructed to follow the EBM learning model of "autonomy-collaboration." Upon completion of the course, questionnaires, records of participants' sentiments and insights, and evidence-based clinical practice reports were used as indicators to evaluate the effectiveness of the training. RESULTS: This learning modality effectively enhanced independent learning ability of the students, stimulated their interest in learning, and strengthened the communication between students and teachers, thereby improving the quality of teaching. CONCLUSION: The novel EBM learning model of "autonomy-collaboration," exhibited robust effectiveness in instruction and facilitated the seamless integration of theoretical knowledge with clinical practice. Consequently, its widespread adoption is strongly recommended.

Empowering diabetes management: The impact of patient-provider collaboration on type 2 diabetes outcomes through autonomy support and shared decision-making.

OBJECTIVES: Through the lens of self-determination theory, this quantitative study investigates how patient-provider collaboration through perceived shared decision-making (SDM) and autonomy support impact type 2 diabetes (T2D) outcomes. METHODS: We sampled 474 individuals over 18 years old who self-identified as having T2D. Completed and valid responses were received from 378 participants from two separate groups in an online survey. Data was analyzed using the IBM Statistical Package for Social Sciences (SPSS), AMOS package, version 28, and Mplus, version 8.8. RESULTS: Patient-provider collaboration through autonomy support improved treatment satisfaction (ß = .16, ρ < .05) and self-management adherence (ß = .43, ρ < .001). While collaboration through SDM improved treatment satisfaction (ß = .25, ρ < .01), it worsened SM adherence (ß = -.31, ρ < .001). The negative impact of SDM on self-management adherence was mitigated by our moderator, coping ability. However, coping ability minimally impacted treatment satisfaction and SM adherence when autonomous support was provided. CONCLUSIONS: Autonomy support increases treatment satisfaction and self-management adherence. SDM enhances treatment satisfaction but may adversely affect self-management adherence. The study also suggests that coping ability can mitigate the negative effect of SDM on self-management adherence, although its influence is limited when autonomy support is provided by the provider. PRACTICAL IMPLICATIONS: For providers, SDM and autonomy support permits shared power over treatment decisions while fostering independence over self-management tasks. Providers should evaluate patients' coping ability and adapt their approach to care based on the patient's coping capacity.