Trust and world view in shared decision making with indigenous patients: A realist synthesis

Abstract

Introduction How shared decision making (SDM) works with indigenous patient values and preferences is not well understood. Colonization has affected indigenous peoples' levels of trust with institutions, and their world view tends to be distinct from that of nonindigenous people. Building on a programme theory for SDM, the present research aims to refine the original programme theory to understand how the mechanisms of trust and world view might work differently for indigenous patients. Design We used a six‐step iterative process for realist synthesis: preliminary programme theory development, search strategy development, selection and appraisal of literature, data extraction, data analysis and synthesis, and formation of a revised programme theory. Data Sources Searches were through Medline, CINAHL, and the University of Saskatchewan iPortal for grey literature. Medline and CINAHL searches included the University of Alberta Canada‐wide indigenous peoples search filters. Data synthesis Following screening 731 references, 90 documents were included for data extraction (53 peer reviewed and 37 grey literature). Documents from countries with similar colonization experiences were included. Results A total of 518 context‐mechanism‐outcome (CMO) configurations were identified and synthesized into 21 CMOs for a revised programme theory. Demographics, indigenous world view, system and institutional support, language barriers, and the macro‐context of discrimination and historical abuse provided the main contexts for the programme theory. These inspired mechanisms of reciprocal respect, perception of world view acceptance, and culturally appropriate knowledge translation. In turn, these mechanisms influenced the level of trust and anxiety experienced by indigenous patients. Trust and anxiety were both mechanisms and intermediate outcomes and determined the level of engagement in SDM. Conclusion This realist synthesis provides clinicians and policymakers a deeper understanding of the complex configurations that influence indigenous patient engagement in SDM and offers possible avenues for improvement.

Service Providers’ Perceptions of Support Needs for Indigenous Cancer Patients in Saskatchewan: A Needs Assessment

“…Participants also recommended more Indigenous representation among service providers for offering culturally relevant support and for facilitating trust between patients and providers. Improving trust between Indigenous patients and health care providers is signi cant, as previous research demonstrates that Indigenous peoples tend to have mistrust towards the Western medical system [11] due to historical [20,21] and ongoing racism experienced within the system [22]. Research with service providers in the province of Ontario demonstrates that systemic discrimination towards Indigenous patients is a barrier to health care, and also recommends the need for cultural safety training [23].…”

The experiences of Indigenous people with cancer in Saskatchewan: a patient-oriented qualitative study using a sharing circle

“…Trust and world view have been shown to play an important role in how Indigenous patients interact with the health care system. 14 Reciprocal respect, perception of world view acceptance and culturally appropriate knowledge translation influence level of trust. 11 Indigenous patients often hold different world views from those of providers and the health care system.…”

“…11 Indigenous patients often hold different world views from those of providers and the health care system. 15 Building on our literature-derived theory of shared decision-making for Indigenous patients, 14 our study explores the perceptions and experiences of Indigen ous patients with cancer and their families to understand how trust and world view influence their cancer care decisions. We engaged 2 Indigenous cancer survivors to partner in our research to ensure that our work maintained a patient-oriented lens.…”

Editorial introduction: Decision making, reasoning, context, and perspective

“…[15][16][17] These papers are followed by articles identifying barriers to the implementation of SDM (again, in a diverse range of social and cultural contexts) and proposing ways of overcoming these barriers. [18][19][20] The edition concludes with a number of papers proposing innovative methods for implementing and evaluating the impact of PCC and SDM. [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] Again, the core concepts of PCC and SDM are explored across a very diverse set of contexts.…”

“…The edition contains several research papers aimed at getting a clearer picture of the patient decision‐making process in a number of areas, in different national contexts . These papers are followed by articles identifying barriers to the implementation of SDM (again, in a diverse range of social and cultural contexts) and proposing ways of overcoming these barriers …”