Barriers and facilitators to shared decision-making among African-Americans with diabetes.
BACKGROUND
Shared decision-making (SDM) between patients and their physicians is associated with improved diabetes health outcomes. African-Americans have less SDM than Whites, which may contribute to diabetes racial disparities. To date, there has been little research on SDM among African-Americans.


OBJECTIVE
We explored the barriers and facilitators to SDM among African-Americans with diabetes.


METHODS
Qualitative research design with a phenomenological methodology using in-depth interviews (n = 24) and five focus groups (n = 27). Each interview/focus group was audio-taped and transcribed verbatim, and coding was conducted using an iterative process.


METHODS
We utilized a purposeful sample of African-American adult patients with diabetes. All patients had insurance and received their care at an academic medical center.


RESULTS
Patients identified multiple SDM barriers/facilitators, including the patient/provider power imbalance that was perceived to be exacerbated by race. Patient-related factors included health literacy, fear/denial, family experiences and self-efficacy. Reported physician-related barriers/facilitators include patient education, validating patient experiences, medical knowledge, accessibility and availability, and interpersonal skills.


CONCLUSIONS
Barriers/facilitators of SDM exist among African-Americans with diabetes, which can be effectively addressed in the outpatient setting. Primary care physicians, particularly academic internists, may be uniquely situated to address these barriers/facilitators and train future physicians to do so as well.
Peek
Monica E
ME
Section of General Internal Medicine, Department of Medicine, University of Chicago, 5841 S. Maryland, Chicago, IL 60637, USA. mpeek@medicine.bsd.uchicago.edu
Wilson
Shannon C
SC
Gorawara-Bhat
Rita
R
Odoms-Young
Angela
A
Quinn
Michael T
MT
Chin
Marshall H
MH
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000208:ethnology* / Q000523:psychology; D000368:Aged; D003657:Decision Making; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D005260:Female; D006801:Humans; D007407:Interviews as Topic / Q000379:methods; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods; D010358:Patient Participation / Q000379:methods / Q000523:psychology; D010817:Physician-Patient Relations; D055815:Young Adult