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

Abstract

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

Improving Equity in Shared Decision Making

“…In the study, overwhelmingly, White clinicians had different observed levels of shared decision making with Black caregivers compared with White caregivers. The study echoes the accumulated work pointing to disparities in current shared decision making interventions and tools . It helps move the needle further to make shared decision making more accountable for different cultural norms, values, and beliefs.…”

An interactive, online decision aid assessing patient goals and preferences for treatment of aortic stenosis to support physician-led shared decision-making: Early feasibility pilot study

“…Without direct elicitation, clinicians must rely on their assumptions about those values and risk making a “preference misdiagnosis [ 44 ].” Those assumptions are also influenced by implicit biases related to age, race, and gender [ 45 , 46 ]. A recent analysis of facilitators for SDM among African American patients highlight patients’ desire for more medical information and the benefit of “facilitating a level-playing field interaction [ 47 ].” Relying on patients’ initial treatment preferences without exploring their values and reasoning can perpetuate disparities in care. In our study, clinicians often underestimated patients’ desire to be involved in decisions, and overestimated the extent to which patients wanted their physician to make the decision.…”

“…Those assumptions are also influenced by implicit biases related to age, race, and gender [45,46]. A recent analysis of facilitators for SDM among African American patients highlight patients' desire for more medical information and the benefit of "facilitating a level-playing field interaction [47]." Relying on patients' initial treatment preferences without exploring their values and reasoning can perpetuate disparities in care.…”

Multiethnic Perspectives of Shared Decision‐Making in Hypertension: A Mixed‐Methods Study

“… 10 Zisman‐Ilani and colleagues reported that patient understanding favored by storytelling in communication, to contextualize medical information, is a facilitator of SDM. 50 …”