Shared Decision Making Among Racially and/or Ethnically Diverse Populations in Primary Care: A Scoping Review of Barriers and Facilitators.

Abstract

Purpose: Disparities in the use of shared decision making (SDM) affect minoritized patients. We sought to identify the barriers and facilitators to SDM among diverse patients.

Methods: We conducted a scoping review in adherence to the Joanna Briggs Institute's methodologic framework. Our search of 4 databases-PubMed, Scopus, CINAHL Plus with Full Text, and PsycINFO-used controlled vocabulary and key word terms related to SDM in the care of racially and/or ethnically diverse adults in the primary care setting. We included peer-reviewed studies conducted in the United States or Canada that evaluated the process of decision making and that had populations in which more than 50% of patients were from racial and/or ethnic minorities. Unique records were uploaded to a screening platform for independent review by 2 team members. We used grounded theory to guide our inductive approach and completed a thematic analysis.

Results: A total of 39 studies met all inclusion criteria. We identified 5 overarching themes: (1) factors regarding the decision-making process during the clinical encounter, (2) clinician practice characteristics, (3) trust in the clinician/health care system, (4) cultural congruence between clinician and patient, and (5) extrinsic factors affecting the decision-making process. Barriers of SDM included cultural and language discordance; prejudice, bias, and stereotypes; mistrust; and clinician time constraints. Facilitators of SDM included cultural concordance between clinician and patient; clinician language competence; and clear, honest, and humanistic communication with patients having the ability to ask questions.

Conclusions: We identified a set of potentially modifiable factors that facilitate or impede SDM. Our findings can help inform strategies and interventions to improve SDM among racially and/or ethnically diverse patient populations.