title: Cultural challenges to engaging patients in shared decision making.
abstract: Engaging patients in their health care through shared decision-making is a priority embraced by several national and international groups. Missing from these initiatives is an understanding of the challenges involved in engaging patients from diverse backgrounds in shared decision-making. In this commentary, we summarize some of the challenges and pose points for consideration regarding how to move toward more culturally appropriate shared decision-making.
  
  
  
  The past decade has seen repeated calls for health policies, research projects and interventions that more actively include patients in decision making. Yet research has shown that patients from different racial/ethnic and cultural backgrounds appraise their decision making process less positively than do white, U.S.-born patients who are the current demographic majority.
  
  
  
  While preliminary conceptual frameworks have been proposed for considering the role of race/ethnicity and culture in healthcare utilization, we maintain that more foundational and empirical work is necessary. We offer recommendations for how to best involve patients early in treatment and how to maximize decision making in the way most meaningful to patients. Innovative and sustained efforts are needed to educate and train providers to communicate effectively in engaging patients in informed, shared decision-making and to provide culturally competent health care.
authors.affiliation: Professor of Medicine and Health Management and Policy, University of Michigan & Research Investigator, Ann Arbor VA Center for Clinical Management Research, 2800 Plymouth Road, 4th Floor, Ann Arbor, MI 48109, United States. Electronic address: sarahawl@umich.edu.
authors.forename: Sarah T
authors.initials: ST
authors.lastname: Hawley
authors.affiliation: Associate Professor of Surgery and Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, United States.
authors.forename: Arden M
authors.initials: AM
authors.lastname: Morris
mesh_terms: D003142:Communication; D054521:Cultural Competency; D018864:Cultural Diversity; D003469:Culture; D003657:Decision Making; D005006:Ethnicity; D006801:Humans; D010358:Patient Participation / Q000379:methods / Q000523:psychology; D057240:Patient Preference; D018802:Patient-Centered Care; D010817:Physician-Patient Relations; D012067:Religion; D035502:Trust
keywords: Cultural challenges; Health care provider-patient communication; Patient engagement; Shared decision-making