Shared decision-making (SDM) between patients and their physicians is associated with improved diabetes health outcomes. African-Americans have fewer opportunities for SDM than Whites, which may contribute to diabetes racial disparities. To date, there has been little research on SDM among African-Americans. Peek and colleagues explored the barriers and facilitators to SDM among African-Americans with diabetes in qualitative research with a phenomenological methodology using in-depth interviews (n = 24) and five focus groups (n = 27). Each interview/focus group was audiotaped and transcribed verbatim; coding was conducted using an iterative process. The investigators utilized a sample of African-American adult patients with diabetes. All patients had insurance and received their care at an academic medical center. 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.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The authors concluded that 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.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: The barriers/facilitators of shared decision making should also be considered in designing a self-management program for diabetic patients. They could make or break any chances of success of a self-management program not only for African Americans with diabetes, but for those with other chronic conditions as well.

ME Peek et al. Barriers and Facilitators to Shared Decision-making Among African-Americans with Diabetes. Journal of General Internal Medicine, July 4, 2009.