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

OBJECTIVE 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. METHODS We performed interviews with 32 Black patients receiving type 2 diabetes care in safety-net primary care practices caring predominantly for Black people. RESULTS 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. 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. Key words: shared decision making; health disparities; Black/African Americans; type 2 diabetes https://doi.org/10.1370/afm.2943 Annals 'Online First' article
INTRODUCTION Type 2 diabetes (T2D) is especially prevalent among racial and ethnic minorities. (1-3) Black and Hispanic Americans are at increased risk of T2D compared with non-Hispanic White Americans, (4) [...]