Are there racial differences in patients' shared decision-making preferences and behaviors among patients with diabetes?
In the United States, African Americans are more likely to experience lower quality patient/provider communication and less shared decision making (SDM) than whites, which may be an important contributor to racial health disparities. Patient factors have not been fully explored as a potential contributor to communication disparities.



The authors analyzed cross-sectional data from a survey of 974 patients with diabetes seen at 34 community health centers (HC) in 17 midwestern and west-central states. They used ordinal and logistic regression models to investigate racial differences in patients' preferences for SDM and in patients' behaviors that may facilitate SDM (initiating discussions about diabetes care).



The response rate was 67%. In bivariate and multivariate analyses, race was not associated with patient preference for a shared role in the 3 measured SDM domains: agenda setting (odds ratio [OR]: 1.13 [0.86, 1.49]), information sharing (OR: 1.26 [0.97, 1.64]), or decision making (OR: 1.16 [0.85, 1.59]). African Americans were more likely to report initiating discussions with their physicians about 4 of 6 areas of diabetes care-blood pressure measurement (66% v. 52%, P < 0.001), foot examination (54% v. 47%, P = 0.04), eye examination (57% v. 46%, P = 0.002), and microalbumin testing (38% v. 29%, P = 0.01)-but not HbA1c testing (39% v. 43%, P = 0.31) or cholesterol testing (53% v. 51%, P = 0.52). In multivariate analysis, African Americans were still more likely to report initiating conversations about diabetes care (OR: 1.78 [1.10, 2.89]).



The authors found that African Americans in this study preferred shared decision making as much as whites and were more likely to report initiating more discussions with their doctors about their diabetes care. This research suggests that, among diabetes patients receiving care at community health centers, patient preference or patient behaviors may be an unlikely cause of racial differences in shared decision making.
Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois (MEP, MHC)|Diabetes Research and Training Center, University of Chicago, Chicago, Illinois (MEP, HT, MHC)|Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois (MEP, HT, MHC)
Monica E
ME
Peek
Diabetes Research and Training Center, University of Chicago, Chicago, Illinois (MEP, HT, MHC)|Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois (MEP, HT, MHC)
Hui
H
Tang
St. Louis Children’s Hospital, St. Louis, Missouri (AC)
Algernon
A
Cargill
Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois (MEP, MHC)|Diabetes Research and Training Center, University of Chicago, Chicago, Illinois (MEP, HT, MHC)|Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois (MEP, HT, MHC)
Marshall H
MH
Chin
D000293:Adolescent; D000328:Adult; D000368:Aged; D000419:Albuminuria; D001794:Blood Pressure; D003142:Communication; D003151:Community Health Centers; D003430:Cross-Sectional Studies; D003657:Decision Making; D003920:Diabetes Mellitus / Q000208:ethnology* / Q000523:psychology; D019538:Health Care Surveys; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011594:Psychometrics; D044469:Racial Groups / Q000523:psychology*; D055815:Young Adult