title: Barriers and facilitators to shared decision-making among African-Americans with diabetes.
abstract: 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.
authors: Section of General Internal Medicine, Department of Medicine, University of Chicago, 5841 S. Maryland, Chicago, IL 60637, USA. mpeek@medicine.bsd.uchicago.edu
authors: Monica E
authors: ME
authors: Peek
authors: Shannon C
authors: SC
authors: Wilson
authors: Rita
authors: R
authors: Gorawara-Bhat
authors: Angela
authors: A
authors: Odoms-Young
authors: Michael T
authors: MT
authors: Quinn
authors: Marshall H
authors: MH
authors: Chin
mesh_terms: 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