Barriers and Facilitators to Shared Decision-making Among African-Americans with Diabetes

  • Monica E. Peek
  • Shannon C. Wilson
  • Rita Gorawara-Bhat
  • Angela Odoms-Young
  • Michael T. Quinn
  • Marshall H. Chin
Brief Report

ABSTRACT

INTRODUCTION

Shared decision-making (SDM) between patients and their physicians is associated with improved diabetes health outcomes. African-Americans have less SDM than Whites, which may contribute to diabetes racial disparities. To date, there has been little research on SDM among African-Americans.

OBJECTIVE

We explored the barriers and facilitators to SDM among African-Americans with diabetes.

METHODS

Qualitative research design with a phenomenological methodology using in-depth interviews (n = 24) and five focus groups (n = 27). Each interview/focus group was audio-taped and transcribed verbatim, and coding was conducted using an iterative process. Participants: We utilized a purposeful sample of African-American adult patients with diabetes. All patients had insurance and received their care at an academic medical center.

RESULTS

Patients identified multiple SDM barriers/facilitators, including the patient/provider power imbalance that was perceived to be exacerbated by race. Patient-related factors included health literacy, fear/denial, family experiences and self-efficacy. Reported physician-related barriers/facilitators include patient education, validating patient experiences, medical knowledge, accessibility and availability, and interpersonal skills.

DISCUSSION

Barriers/facilitators of SDM exist among African-Americans with diabetes, which can be effectively addressed in the outpatient setting. Primary care physicians, particularly academic internists, may be uniquely situated to address these barriers/facilitators and train future physicians to do so as well.

KEY WORDS

shared decision-making patient-provider communication diabetes African-Americans 

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Copyright information

© Society of General Internal Medicine 2009

Authors and Affiliations

  • Monica E. Peek
    • 1
    • 2
    • 3
    • 4
  • Shannon C. Wilson
    • 1
    • 2
  • Rita Gorawara-Bhat
    • 2
    • 5
  • Angela Odoms-Young
    • 2
    • 6
  • Michael T. Quinn
    • 1
    • 2
    • 3
  • Marshall H. Chin
    • 1
    • 2
    • 3
  1. 1.Section of General Internal Medicine, Department of MedicineUniversity of ChicagoChicagoUSA
  2. 2.Diabetes Research and Training CenterUniversity of ChicagoChicagoUSA
  3. 3.Center for Health and the Social SciencesUniversity of ChicagoChicagoUSA
  4. 4.Center for the Study of Race, Politics and CultureUniversity of ChicagoChicagoUSA
  5. 5.Section of Geriatrics and Palliative Care, Department of MedicineUniversity of ChicagoChicagoUSA
  6. 6.Department of Kinesiology and NutritionUniversity of Illinois at ChicagoChicagoUSA

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