Minority Health Archive

Race and shared decision-making: Perspectives of African-Americans with diabetes

Peek, Monica E. and Odoms-Young, Angela and Quinn, Michael T. and Gorawara-Bhat, Rita and Wilson, Shannon C. and Chin, Marshall H. (2010) Race and shared decision-making: Perspectives of African-Americans with diabetes. Social Science & Medicine, 71 (1). pp. 1-9. ISSN 02779536

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Abstract

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.


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Item Type: Article
Additional Information: This article is available at the publisher’s Web site. Access to the full text is subject to the publisher’s access restrictions.
Uncontrolled Keywords: bidirectional dialogue, treatment plans, racial disparities, diabetes
Subjects: Health > Health Equity
Health > Public Health > Chronic Illness & Diseases > Diabetes
Research > studies
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Depositing User: Users 141 not found.
Date Deposited: 25 May 2011 11:38
Last Modified: 30 Jun 2011 16:58
Link to this item (URI): http://health-equity.lib.umd.edu/id/eprint/2512

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