Disparities in Shared Decision-Making Research and Practice: The Case for Black American Patients

The Annals of Family Medicine, vol. 21, pp. 112–118

Abstract

OBJECTIVE The extent of shared decision making (SDM) use in the care of Black patients is limited. We explored preferences, needs, and challenges of Black patients to enhance SDM offerings. METHODS We performed interviews with 32 Black patients receiving type 2 diabetes care in safety-net primary care practices caring predominantly for Black people. RESULTS The following 4 themes emerged: preference for humanistic communication, need to account for the role of family in decision making, need for medical information sharing, and mistrust of clinicians. CONCLUSION Given the dearth of research on SDM among ethnic and racial minorities, this study offers patient-perspective recommendations to improve SDM offerings for Black patients in primary care settings. To enhance SDM with Black patients, acknowledgment of the importance of storytelling as a strategy, to place medical information in a context that makes it meaningful and memorable, is recommended. Triadic SDM, in which family members are centrally involved in decision making, is preferred over classical dyadic SDM. There is a need to reconsider the universalism assumption underlying contemporary SDM models and the relevancy of current SDM practices that were developed mostly without the feedback of participants of ethnic, racial, and cultural minorities. Annals “Online First” article

Authors 13

1. Yaara Zisman‐Ilani

   University College London · Temple University

   Affiliation as printed

   College of Public Health, Temple University, Philadelphia, Pennsylvania yaara@temple.edu

   Division of Psychology and Language Sciences, University College London, London, United Kingdom

   Shared Decision Making Laboratory, Temple University, Philadelphia, Pennsylvania

   College of Public Health, Temple University, Philadelphia, Pennsylvania

2. Shely Khaikin

   Temple University

   Affiliation as printed

   Shared Decision Making Laboratory, Temple University, Philadelphia, Pennsylvania

3. Margot Latrese Savoy

   American Academy of Family Physicians · Temple University

   Affiliation as printed

   American Academy of Family Physicians, Washington, DC

   Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania

4. Anuradha Paranjape

   Temple University

   Affiliation as printed

   Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania

5. Daniel J. Rubin

   Temple University

   Affiliation as printed

   Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania

6. Regina A. Jacob

   Temple University

   Affiliation as printed

   Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania

7. Thomas H. Wieringa Aachen Department of Biomedical Data Sciences

   Leiden University Medical Center

   Affiliation as printed

   Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands

8. John Suarez

   Temple University

   Affiliation as printed

   Shared Decision Making Laboratory, Temple University, Philadelphia, Pennsylvania

9. Jin Liu

   Temple University

   Affiliation as printed

   Shared Decision Making Laboratory, Temple University, Philadelphia, Pennsylvania

10. Heather M. Gardiner

    Temple University

    Affiliation as printed

    College of Public Health, Temple University, Philadelphia, Pennsylvania

11. Sarah Bauerle Bass

    Temple University

    Affiliation as printed

    College of Public Health, Temple University, Philadelphia, Pennsylvania

12. Víctor M. Montori

    Mayo Clinic

    Affiliation as printed

    Mayo Clinic, Rochester, Minnesota

13. Laura A. Siminoff

    Temple University

    Affiliation as printed

    College of Public Health, Temple University, Philadelphia, Pennsylvania