Use of Decision Aids with Minority Patients: a Systematic Review

Nathan, Aviva G.; Marshall, Imani M.; Cooper, Jennifer; Huang, Elbert S.

doi:10.1007/s11606-016-3609-2

Cited by 58 publications

(43 citation statements)

References 44 publications

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“…All of the studies focused on HIV infection and none dealt with African-American women who were sexual minorities or African-American transgender men. While research indicates that decision-aids can improve shared decision making among racial/ethnic minorities, 83 none of our studies identified clinical tools such as decision aids to assist in SDM among African-American LGBT persons. And although concerns about healthcare discrimination and other organizational factors (e.g., loss of privacy) were noted themes, we did not find any organizational or clinician interventions to improve SDM among this population.…”

Section: Discussionmentioning

confidence: 82%

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

et al. 2016

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BACKGROUND: Enhancing patient-centered care and shared decision making (SDM) has become a national priority as a means of engaging patients in their care, improving treatment adherence, and enhancing health outcomes. Relatively little is known about the healthcare experiences or shared decision making among racial/ethnic minorities who also identify as being LGBT. The purpose of this paper is to understand how race, sexual orientation and gender identity can simultaneously influence SDM among AfricanAmerican LGBT persons, and to propose a model of SDM between such patients and their healthcare providers. METHODS: We reviewed key constructs necessary for understanding SDM among African-American LGBT persons, which guided our systematic literature review. Eligible studies for the review included English-language studies of adults (≥ 19 y/o) in North America, with a focus on LGBT persons who were African-American/black (i.e., > 50 % of the study population) or included sub-analyses by sexual orientation/gender identity and race. We searched PubMed, CINAHL, ProQuest Dissertations & Theses, PsycINFO, and Scopus databases using MESH terms and keywords related to shared decision making, communication quality (e.g., trust, bias), African-Americans, and LGBT persons. Additional references were identified by manual reviews of peer-reviewed journals' tables of contents and key papers' references. RESULTS: We identified 2298 abstracts, three of which met the inclusion criteria. Of the included studies, one was cross-sectional and two were qualitative; one study involved transgender women (91 % minorities, 65 % of whom were African-Americans), and two involved African-American men who have sex with men (MSM). All of the studies focused on HIV infection. Sexual orientation and gender identity were patient-reported factors that negatively impacted patient/provider relationships and SDM. Engaging in SDM helped some patients overcome normative beliefs about clinical encounters. In this paper, we present a conceptual model for understanding SDM in African-American LGBT persons, wherein multiple systems of social stratification (e.g., race, gender, sexual orientation) influence patient and provider perceptions, behaviors, and shared decision making. DISCUSSION: Few studies exist that explore SDM among African-American LGBT persons, and no interventions were identified in our systematic review. Thus, we are unable to draw conclusions about the effect size of SDM among this population on health outcomes. Qualitative work suggests that race, sexual orientation and gender work collectively to enhance perceptions of discrimination and decrease SDM among African-American LGBT persons. More research is needed to obtain a comprehensive understanding of shared decision making and subsequent health outcomes among African-Americans along the entire spectrum of gender and sexual orientation.

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Section: Discussionmentioning

confidence: 82%

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

et al. 2016

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“…104 Best practices for implementing and evaluating DAs exist, but do not address minority patients specifically. 105,106 Preliminary evidence suggests that DAs can improve communication and psychological outcomes for racial/ethnic minority populations; however, existing decision aids cover a limited range of topics and rarely address LGBT patients. 106 Tailored educational materials support patient satisfaction, understanding, and adherence to treatment.…”

Section: Decision Aids and Educational Materialsmentioning

confidence: 99%

“…105,106 Preliminary evidence suggests that DAs can improve communication and psychological outcomes for racial/ethnic minority populations; however, existing decision aids cover a limited range of topics and rarely address LGBT patients. 106 Tailored educational materials support patient satisfaction, understanding, and adherence to treatment. 42,43 For most minority patients, cultural tailoring goes beyond language 107 and literacy; 108 for example, LGBT-specific educational materials can help LGBT patients discuss their options and preferences with clinicians.…”

Section: Decision Aids and Educational Materialsmentioning

confidence: 99%

A Model of Organizational Context and Shared Decision Making: Application to LGBT Racial and Ethnic Minority Patients

et al. 2016

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Shared decision making (SDM) occurs when patients and clinicians work together to reach care decisions that are both medically sound and responsive to patients' preferences and values. SDM is an important tenet of patient-centered care that can improve patient outcomes. Patients with multiple minority identities, such as sexual orientation and race/ethnicity, are at particular risk for poor SDM. Among these dualminority patients, added challenges to clear and open communication include cultural barriers, distrust, and a health care provider's lack of awareness of the patient's minority sexual orientation or gender identity. However, organizational factors like a culture of inclusion and private space throughout the visit can improve SDM with lesbian, gay, bisexual, and transgender (BLGBT^) racial/ethnic minority patients who have faced stigma and discrimination. Most models of shared decision making focus on the patient-provider interaction, but the health care organization's context is also critical. Context-an organization's structure and operations-can strongly influence the ability and willingness of patients and clinicians to engage in shared decision making. SDM is most likely to be optimal if organizations transform their contexts and patients and providers improve their communication. Thus, we propose a conceptual model that suggests ways in which organizations can shape their contextual structure and operations to support SDM. The model contains six drivers: workflows, health information technology, organizational structure and culture, resources and clinic environment, training and education, and incentives and disincentives. These drivers work through four mechanisms to impact care: continuity and coordination, the ease of SDM, knowledge and skills, and attitudes and beliefs. These mechanisms can activate clinicians and patients to engage in high-quality SDM. We provide examples of how specific contextual changes could make SDM more effective for LGBT racial/ethnic minority populations, focusing especially on transformations that would establish a safe environment, build trust, and decrease stigma.

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“…[6][7][8] The three papers outline a conceptual model for SDM with LGBT racial/ethnic minority patients, and then present information that may guide interventions to assist individual clinicians and patients in improving their SDM, and may help health care organizations transform their structures to facilitate SDM.…”

mentioning

confidence: 99%

“…In a systematic review, Nathan et al found that decision aids have improved communication and psychological outcomes in racial/ethnic minority populations. 7 However, they identified only one study of decision aids in sexual minorities and none for transgender patients.…”

mentioning

confidence: 99%