Shared decision-making in an intercultural context. Barriers in the interaction between physicians and immigrant patients.
OBJECTIVE
The objective of this exploratory paper is to describe several barriers in shared decision-making in an intercultural context.


METHODS
Based on the prevailing literature on intercultural communication in medical settings, four conceptual barriers were described. When the conceptual barriers were described, they were compared with the results from semi-structured interviews with purposively selected physicians (n = 18) and immigrant patients (n = 13). Physicians differed in medical discipline (GPs, company doctors, an internist, a cardiologist, a gynaecologist, and an intern) and patients had different ethnic and immigration backgrounds.


RESULTS
The following barriers were found: (1) physician and patient may not share the same linguistic background; (2) physician and patient may not share similar values about health and illness; (3) physician and patient may not have similar role expectations; and (4) physician and patient may have prejudices and do not speak to each other in an unbiased manner.


CONCLUSIONS
We conclude that due to these barriers, the transfer of information, the formulation of the diagnosis, and the discussion of treatment options are at stake and the shared decision-making process is impeded.


CONCLUSIONS
Improving physician's skills to recognize the communication limitations during shared decision-making as well as improving the skills to deal with the barriers may help to ameliorate shared decision-making in an intercultural setting.
Suurmond
Jeanine
J
University of Amsterdam/Academic Medical Center, Department of Social Medicine, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands. j.suurmond@amc.uva.nl
Seeleman
Conny
C
D003144:Communication Barriers; D003466:Cultural Characteristics; D003657:Decision Making; D006801:Humans; D010819:Physician's Role; D010817:Physician-Patient Relations; D011287:Prejudice