title: Genders of patients and clinicians and their effect on shared decision making: a participant-level meta-analysis.
abstract: BACKGROUND
  Gender differences in communication styles between clinicians and patients have been postulated to impact patient care, but the extent to which the gender dyad structure impacts outcomes in shared decision making remains unclear.
  
  
  METHODS
  Participant-level meta-analysis of 775 clinical encounters within 7 randomized trials where decision aids, shared decision making tools, were used at the point of care. Outcomes analysed include decisional conflict scale scores, satisfaction with the clinical encounter, concordance between stated decision and action taken, and degree of patient engagement by the clinician using the OPTION scale. An estimated minimal important difference was used to determine if nonsignificant results could be explained by low power.
  
  
  RESULTS
  We did not find a statistically significant interaction between clinician/patient gender mix and arm for decisional conflict, satisfaction with the clinical encounter or patient engagement. A borderline significant interaction (p = 0.05) was observed for one outcome: concordance between stated decision and action taken, where encounters with female clinician/male patient showed increased concordance in the decision aid arm compared to control (8% more concordant encounters). All other gender dyads showed decreased concordance with decision aid use (6% fewer concordant encounters for same-gender, 16% fewer concordant encounters for male clinician/female patient).
  
  
  CONCLUSIONS
  In this participant-level meta-analysis of 7 randomized trials, decision aids used at the point of care demonstrated comparable efficacy across gender dyads. Purported barriers to shared decision making based on gender were not detected when tested for a minimum detected difference.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00888537, NCT01077037, NCT01029288, NCT00388050, NCT00578981, NCT00949611, NCT00217061.
authors.forename: Kirk D
authors.initials: KD
authors.lastname: Wyatt
authors.forename: Megan E
authors.initials: ME
authors.lastname: Branda
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Inselman
authors.forename: Henry H
authors.initials: HH
authors.lastname: Ting
authors.forename: Erik P
authors.initials: EP
authors.lastname: Hess
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
authors.affiliation: Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, 200 First St, SW, Rochester, MN 55905, USA. LeBlanc.Annie@mayo.edu.
authors.forename: Annie
authors.initials: A
authors.lastname: LeBlanc
mesh_terms: D000368:Aged; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation / Q000706:statistics & numerical data*; D011369:Professional-Patient Relations; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data*; D012737:Sex Factors