Anaya Yohualli, Do Diana, Christensen Leslie, Schrager Sarina
Department of Family of Medicine and Community Health, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin.
Ann Fam Med. 2025 Mar 24;23(2):108-116. doi: 10.1370/afm.240087.
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.
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.
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.
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.
共享决策（SDM）使用方面的差异影响了少数族裔患者。我们试图确定不同患者群体中共享决策的障碍和促进因素。
我们按照乔安娜·布里格斯研究所的方法框架进行了一项范围综述。我们在4个数据库——PubMed、Scopus、CINAHL全文数据库和PsycINFO中进行检索，使用了与初级保健环境中不同种族和/或族裔成年人护理中的共享决策相关的控制词汇和关键词。我们纳入了在美国或加拿大进行的、评估决策过程且患者中超过50%来自种族和/或族裔少数群体的同行评审研究。将独特的记录上传到筛选平台，由2名团队成员进行独立评审。我们使用扎根理论来指导归纳方法，并完成了主题分析。
共有39项研究符合所有纳入标准。我们确定了5个总体主题：（1）临床会诊期间决策过程的相关因素，（2）临床医生的实践特征，（3）对临床医生/医疗保健系统的信任，（4）临床医生与患者之间的文化契合度，以及（5）影响决策过程的外部因素。共享决策的障碍包括文化和语言不一致；偏见、歧视和刻板印象；不信任；以及临床医生的时间限制。共享决策的促进因素包括临床医生与患者之间的文化契合度；临床医生的语言能力；以及与有提问能力的患者进行清晰、诚实和人文的沟通。
我们确定了一组可能可改变的促进或阻碍共享决策的因素。我们的研究结果可为改善不同种族和/或族裔患者群体中共享决策的策略和干预措施提供参考。
