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

• Published in: Annals of family medicine Vol. 21; no. 2; pp. 112 - 118
• Main Authors: Zisman-Ilani, Yaara, Khaikin, Shely, Savoy, Margot L., Paranjape, Anuradha, Rubin, Daniel J., Jacob, Regina, Wieringa, Thomas H., Suarez, John, Liu, Jin, Gardiner, Heather, Bass, Sarah Bauerle, Montori, Victor M., Siminoff, Laura A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2023; Annals of Family Medicine; American Academy of Family Physicians
• Subjects: African Americans; Black or African American; Black/African Americans; Care and treatment; Decision Making; Decision Making, Shared; Decision-making, Group; Demographic aspects; Diabetes Mellitus, Type 2 - therapy; Family Medicine/General Medicine; Health aspects; Health care disparities; health disparities; Humans; Internal Medicine; Original Research; Patient Participation; Primary health care; Quality management; shared decision making; Social aspects; Type 2 diabetes; United States; shared decision making; Black/African Americans; health disparities; type 2 diabetes
• ISSN: 1544-1709; 1544-1717; 1544-1717
• DOI: 10.1370/afm.2943

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. We performed interviews with 32 Black patients receiving type 2 diabetes care in safety-net primary care practices caring predominantly for Black people. 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. 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.