Disparities in Shared Decision-Making Research and Practice: The Case for Black American Patients

Yaara Zisman-Ilani; Shely Khaikin; Margot L. Savoy; Anuradha Paranjape; Daniel J. Rubin; Regina Jacob; Thomas H. Wieringa; John Suarez; Jin Liu; Heather Gardiner; Sarah Bauerle Bass; Victor M. Montori; Laura A. Siminoff

doi:10.1370/afm.2943

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Table 1.

Demographic and Clinical Characteristics (N = 32)

Variable	Mean (SD)	No. (%)
Age, y	59 (11.9)
18-39		3 (9)
40-65		20 (63)
>65		9 (28)
Female		17 (53)
Black Americans		32 (100)
Marital status
Single		10 (31)
Married		13 (41)
Separated/divorced/widowed		9 (28)
Education, y
9-11		7 (22)
12		14 (44)
>13		11 (34)
Employment status
Full-time		6 (19)
Part-time		3 (9)
Irregular work/unemployed/other		23 (72)
Primary diagnosis
Type 2 diabetes		32 (100)
Total participants with comorbidities		26 (81)
Treatment regimen (n = 26)
Diet		1 (4)
Oral drugs and/or diet		11 (42)
Insulin		4 (15)
Oral drugs and/or insulin		7 (27)
Insulin and/or GLP1RA		3 (12)
HbA_1c (%)	8.96 (2.7)

GLP1RA = glucagon-like peptide-1 receptor agonist; HbA_1c = hemoglobin A_1c.

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Table 2.

Themes and Subthemes Suggesting Encouraged Clinician Behaviors and Pertinent Quotes

Preference for humanistic communication
Show empathy and build rapport	[I like that] the doctor was a person that was a human being. She cared. She listens to you. She just don’t zoom in like you’re in a factory on the assembly line. She takes time out and listens to her patients. And she enthused me. (59-year-old woman)
Use ice-breaker gestures	He [the doctor] laughed at my jokes. I mean, it weren’t like they weren’t funny, but he laughed at my jokes. I had him cracking up. And that was when I was in a lot of pain. (52-year-old man)
Facilitate level-playing-field interaction	My doctor never talking against me. He’s always talking with me. It’s always what you really need to consider, what you really need to do, what you need to really make happen right away. (66-year-old man)
Need to account for the central role of family members in decision making
	He [the doctor] takes his time with us to talk because me and my mama come together [to the appointment] and he talks to both of us. She had diabetes too. So however long it takes he’ll take his time with us. (59-year-old woman)
Need for more medical information
	My doctor decided to give me medication. I had been on the borderline for like 2 years. And so I can’t remember exactly why he decided to prescribe medication, which I don’t fully understand. I don’t feel that I need it, but he’s a doctor, so I go along with it. But I still have in the back of my mind, why do I need medication?? Because usually, I take my sugar glucose. I’m supposed to do it twice a day, but I only do it once. But it’s never beyond 120. Usually the range it runs like 114, 104, below like 120. I never have a glucose reading of 150 or 200. I think it’s [supposed to be excessive in the] 200 range, 150 range or something. But I never had that, so I don’t fully understand. I’m being treated because my doctor recommended with medication. That’s when I got metformin. But I don’t fully understand it, but that’s what he prescribes. So he’s a doctor. (77-year-old woman)
Mistrust of clinicians
Decrease autopilot communication	He’ll [the doctor] come in and say “Good morning,” “How is my day,” all these type of things, “What are you here for today?” and I look like, Why did he ask me that? Ain’t he supposed to know?? [...] I think that doctors don’t have to converse with you like, “How’s your kids or mom? Did you see the game yesterday?” or something like that, but at least acknowledge that your patient isn’t patient number 42. (61-year-old woman)
Be direct and open	His [the doctor’s] approach is perfect, in my opinion. Somebody else, it may not fit. But he just straight with me, I’m straight with him. Anything he ask, I blurt out. (52-year-old man)

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Table 3.

Distribution of SDM-Q-9 Items (N = 32, range 1-6)

	Mean (SD)
Mean score	5.03 (0.57)
Sum score	80.5 (11.5)
Individual items
1. My doctor makes clear that a decision needs to be made.	5.0 (0.92)
2. My doctor wants to know exactly how I want to be involved in making the decision.	5.0 (0.6)
3. My doctor tells me there are different options for treating my medical condition.	4.91 (0.96)
4. My doctor precisely explains the advantages and disadvantages of the treatment options.	5.05 (0.67)
5. My doctor helps me understand all the information.	5.25 (0.51)
6. My doctor asks me which treatment option I prefer.	4.72 (0.51)
7. My doctor and I thoroughly weigh the different treatment options.	4.72 (1.28)
8. My doctor and I select a treatment option together.	5.13 (0.83)
9. My doctor and I reach an agreement on how to proceed.	5.16 (0.77)