title: Shared decision making in the safety net: where do we go from here?
abstract: BACKGROUND
  Shared decision making (SDM) is an interactive process between clinicians and patients in which both share information, deliberate together, and make clinical decisions. Clinics serving safety net patients face special challenges, including fewer resources and more challenging work environments. The use of SDM within safety net institutions has not been well studied.
  
  
  METHODS
  We recruited a convenience sample of 15 safety net primary care clinicians (13 physicians, 2 nurse practitioners). Each answered a 9-item SDM questionnaire and participated in a semistructured interview. From the transcribed interviews and questionnaire data, we identified themes and suggestions for introducing SDM into a safety net environment.
  
  
  RESULTS
  Clinicians reported only partially fulfilling the central components of SDM (sharing information, deliberating, and decision making). Most clinicians expressed interest in SDM by stating that they "selected a treatment option together" with patients (8 of 15 in strong or complete agreement), but only a minority (3 of 15) "thoroughly weighed the different treatment options" together with patients. Clinicians attributed this gap to many barriers, including time pressure, overwhelming visit content, patient preferences, and lack of available resources. All clinicians believed that lack of time made it difficult to practice SDM.
  
  
  CONCLUSIONS
  To increase use of SDM in the safety net, efficient SDM interventions designed for this environment, team care, and patient engagement in SDM will need further development. Future studies should focus on adapting SDM to safety net settings and determine whether SDM can reduce health care disparities.
authors.affiliation: the Department of Medicine, the Minneapolis Medical Research Foundation, and the Division of General Internal Medicine, Hennepin County Medical Center, Minneapolis, MN; the Department of Sociology and Anthropology, University of Lumière, Lyon, France; the Department of International Health, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands; Knowledge and Evaluation Research Unit, Department of Health Sciences Research, Mayo Clinic, Rochester, MN; and the Department of Medicine, University of Minnesota, Minneapolis, MN.
authors.forename: Angelique B
authors.initials: AB
authors.lastname: Bouma
authors.forename: Kristina
authors.initials: K
authors.lastname: Tiedje
authors.forename: Sara
authors.initials: S
authors.lastname: Poplau
authors.forename: Deborah H
authors.initials: DH
authors.lastname: Boehm
authors.forename: Nilay D
authors.initials: ND
authors.lastname: Shah
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Commers
authors.forename: Mark
authors.initials: M
authors.lastname: Linzer
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
mesh_terms: D001291:Attitude of Health Personnel; D003657:Decision Making; D054625:Healthcare Disparities; D006801:Humans; D007407:Interviews as Topic; D008910:Minnesota; D010358:Patient Participation / Q000379:methods / Q000706:statistics & numerical data*; D057240:Patient Preference; D057184:Practice Patterns, Nurses' / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research; D064876:Safety-net Providers / Q000458:organization & administration* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
keywords: Patient Preference; Safety Net Clinics; Shared Decision Making