Race and shared decision-making: perspectives of African-Americans with diabetes.
Shared decision-making (SDM) is an important component of patient-centered healthcare and is positively associated with improved health outcomes (e.g. diabetes and hypertension control). In shared decision-making, patients and physicians engage in bidirectional dialogue about patients' symptoms and treatment options, and select treatment plans that address patient preferences. Existing research shows that African-Americans experience SDM less often than whites, a fact which may contribute to racial disparities in diabetes outcomes. Yet little is known about the reasons for racial disparities in shared decision-making. We explored patient perceptions of how race may influence SDM between African-American patients and their physicians. We conducted in-depth interviews (n=24) and five focus groups (n=27) among a purposeful sample of African-American diabetes patients aged over 21 years, at an urban academic medical center in Chicago. Each interview/focus group was audio-taped, transcribed verbatim and imported into Atlas.ti software. Coding was conducted iteratively; each transcription was independently coded by two research team members. Although there was heterogeneity in patients' perceptions about the influence of race on SDM, in each of the SDM domains (information-sharing, deliberation/physician recommendations, and decision-making), participants identified a range of race-related issues that may influence SDM. Participants identified physician bias/discrimination and/or cultural discordance as issues that may influence physician-related SDM behaviors (e.g. less likely to share information such as test results and more likely to be domineering with African-American patients). They identified mistrust of white physicians, negative attitudes and internalized racism as patient-related issues that may influence African-American patients' SDM behaviors (e.g. less forthcoming with physicians about health information, more deference to physicians, less likely to adhere to treatment regimens). This study suggests that race-related patient and physician-related barriers may serve as significant barriers to shared decision-making between African-American patients and their physicians. Finding innovative ways to address such communication barriers is an important area of future research.
Peek
Monica E
ME
The University of Chicago, Department of Medicine, 5841 S. Maryland Avenue, MC 2007, Chicago, IL 60637, USA. mpeek@medicine.bsd.uchicago.edu
Odoms-Young
Angela
A
Quinn
Michael T
MT
Gorawara-Bhat
Rita
R
Wilson
Shannon C
SC
Chin
Marshall H
MH
D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000523:psychology / Q000706:statistics & numerical data; D000368:Aged; D001291:Attitude of Health Personnel; D001294:Attitude to Health / Q000208:ethnology; D002641:Chicago; D003920:Diabetes Mellitus / Q000208:ethnology* / Q000628:therapy; D017144:Focus Groups; D054625:Healthcare Disparities; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D010817:Physician-Patient Relations; D011287:Prejudice; D036301:Qualitative Research; D013637:Tape Recording; D019037:Urban Health Services; D055815:Young Adult
J Gen Intern Med. 2004 Jan;19(1):69-77
14748863
J Acquir Immune Defic Syndr. 2000 Apr 15;23(5):396-404
10866232
Soc Sci Med. 1997 Mar;44(5):681-92
9032835
Soc Sci Med. 1999 Sep;49(5):651-61
10452420
Am J Orthopsychiatry. 2000 Jan;70(1):42-57
10702849
Z Arztl Fortbild Qualitatssich. 2007;101(4):241-6
17601179
J Fam Pract. 2000 Sep;49(9):796-804
11032203
Med Care. 2003 Nov;41(11):1221-32
14583685
Dis Manag. 2004 Spring;7(1):25-34
15035831
Ann Intern Med. 1998 Oct 15;129(8):605-12
9786807
Circulation. 2003 Sep 2;108(9):1089-94
12939228
Am J Public Health. 1997 Nov;87(11):1773-8
9366634
J Gen Intern Med. 2007 Sep;22(9):1231-8
17594129
Am J Public Health. 2000 Aug;90(8):1212-5
10936998
Community Ment Health J. 2006 Dec;42(6):555-70
16897412
Soc Sci Med. 2000 Mar;50(6):813-28
10695979
Am J Prev Med. 2004 Jan;26(1):56-66
14700714
Patient Educ Couns. 2008 Sep;72(3):450-8
18684581
Diabetes Educ. 1996 Jan-Feb;22(1):28-33
8697953
Public Health Rep. 2003 Jul-Aug;118(4):358-65
12815085
Arch Intern Med. 2007 Jun 25;167(12):1233-9
17592095
Issue Brief (Commonw Fund). 2004 Apr;(729):1-6
15077607
J Pers Soc Psychol. 2003 May;84(5):1079-92
12757150
Med Care. 2008 Apr;46(4):410-6
18362821
Ann Allergy Asthma Immunol. 2001 Mar;86(3):263-71
11289322
Diabetes Care. 2001 Mar;24(3):454-9
11289467
J Natl Med Assoc. 2001 Oct;93(10):380-5
11688918
J Gen Intern Med. 1990 Mar-Apr;5(2):120-1
2313403
J Gen Intern Med. 1990 Jan-Feb;5(1):29-33
2299426
Am J Med. 2000 May;108(7):561-6
10806285
Behav Med. 1998 Summer;24(2):81-8
9695899
Diabetes Care. 2003 Apr;26(4):1040-6
12663570
Health Expect. 2006 Mar;9(1):25-36
16436159
JAMA. 1999 Aug 11;282(6):583-9
10450723
Ann Intern Med. 1985 Apr;102(4):520-8
3977198
JAMA. 2000 May 3;283(17):2253-9
10807384
Adv Chronic Kidney Dis. 2005 Apr;12(2):196-201
15822055
JAMA. 2002 Mar 13;287(10):1288-94
11886320
J Gen Intern Med. 1988 Sep-Oct;3(5):448-57
3049968
Am J Public Health. 2004 Dec;94(12):2084-90
15569958
Soc Sci Med. 2001 Aug;53(4):519-29
11459401
Diabetes Care. 2004 Oct;27(10):2317-24
15451894
Ann Intern Med. 2003 Dec 2;139(11):907-15
14644893
CMAJ. 1995 May 1;152(9):1423-33
7728691
Pediatr Nurs. 2000 May-Jun;26(3):296-300, 328
12026393
Arch Intern Med. 2002 Apr 22;162(8):929-35
11966345
Crit Care Med. 2007 Feb;35(2):605-22
17205007
J Gen Intern Med. 2006 Jun;21(6):642-7
16808750
J Pers Soc Psychol. 2008 Apr;94(4):615-30
18361675