Shared decision-making among diverse populations in primary care: a scoping review of facilitators and barriers

Purpose: Disparities in the use of shared decision-making (SDM) affect minoritized patients. This scoping review seeks to identify the barriers and facilitators to SDM among diverse patients to help inform clinicians and improve SDM in primary care.

Methods: We searched 4 databases: Scopus (Elsevier), CINAHL Plus with Full Text (EBSCO), and PsycINFO (EBSCO). This search combined controlled vocabulary and keyword terms related to SDM in the care of racially, ethnically, and culturally diverse patients in the primary care setting. We included peer-reviewed studies with original data based in the US and Canada on SDM in adults in primary care outpatient settings. We included papers about the process of decision making that included more than 50 % of their subjects as racial or ethnically diverse. Unique records were uploaded to a screening platform (Covidence) for independent review by 2 team members using these criteria. Grounded theory was used as an inductive approach to analyze themes.

Results: 39 papers met all the inclusion criteria. We identified 5 overarching themes of SDM in diverse populations: Factors regarding the decision-making process during the clinical encounter, clinician practice characteristics, trust in the clinician/healthcare system, cultural congruence, and extrinsic factors affecting the decision-making process. Facilitators to SDM included cultural concordance, language competence, clear, honest, and humanistic communication, and having the ability to ask questions. Barriers included cultural discordance, language barriers, prejudice/bias/stereotypes, mistrust, and provider time constraints.

Conclusions: Our findings highlight how health care providers and systems can support SDM in diverse populations within primary care.