Patient Trust in Physicians and Shared Decision-Making Among African-Americans With Diabetes

Abstract

This study explores patient trust in physicians and its relationship to shared decision-making (SDM) among African-Americans with diabetes (types 1 and 2). We conducted a series of focus groups (n = 27) and in-depth interviews (n = 24). Topic guides were developed utilizing theoretical constructs. Each interview was audiotaped and transcribed verbatim. Each transcript was independently coded by two randomly assigned members of the research team; codes and themes were identified in an iterative fashion utilizing Atlas.ti software. The mean age of study participants was 62 years and 85% were female. We found that (1) race as a social construct has the potential to influence key domains of patient trust (interpersonal/relationship aspects and medical skills/technical competence), (2) the relationship between patient trust and shared decision-making is bidirectional in nature, and (3) enhancing patient trust may potentially increase or decrease SDM among African-Americans with diabetes. Mistrust of physicians among African-Americans with diabetes may partially be addressed through (1) patient education efforts, (2) physician training in interpersonal skills and cultural competence, and (3) physician efforts to engage patients in SDM. To help enhance patient outcomes among African-Americans with diabetes, physicians might consider incorporating strategies to simultaneously engender their patients' trust and encourage shared decision-making.

English Language Proficiency, Health Literacy, and Trust in Physician Are Associated with Shared Decision Making in Rheumatoid Arthritis

“…Several factors known to influence patient-provider communication and shared decision-making (SDM) in other conditions such as diabetes and coronary heart disease include trust in physician, race/ethnicity, education level, employment status, depression, and limited English proficiency (LEP) (9–15). While these factors have been associated with clinician-patient communication in other chronic diseases, they have not been examined in ethnically and linguistically diverse populations with RA, particularly among those patients at highest risk for poor outcomes and with barriers to communication, such as LEP and limited health literacy.…”

Development of a Conceptual Framework for Understanding Shared Decision making Among African-American LGBT Patients and their Clinicians

“…Thus, fully engaging African-American LGBT persons in shared decision making requires that physicians and health systems work to create equal, trusting relationships with patients and also ensure equal access to treatment options and medical care. 13,69,[80][81][82] It is important to note that both physicians and patients are impacted by the relative privilege and disadvantage associated with multiple systems of social stratification. The healthcare setting is a structural system in which there is a hierarchy of power/advantage based on roles (e.g., physician vs. clerical staff, physician vs. patient) as well as social identities (e.g., race, gender, sexual orientation).…”

Does Decisional Conflict Differ Across Race and Ethnicity Groups? A Study of Parents Whose Children Have a Life-Threatening Illness

“…A volume of evidence suggests that decisional conflict for minorities is rooted in mistrust and miscommunication. 22,23 Issues related to mistrust and its impact on decisional conflict are particularly relevant given the evidence of racial disparities in health care. 24 Results from both the unadjusted and adjusted subgroup analyses show that parents who identify as Mexican and Central/South Americans had higher levels of decisional conflict compared to all other Latino subgroups.…”