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      Barriers and facilitators to shared decision-making among African-Americans with diabetes.

      Journal of General Internal Medicine
      Adolescent, Adult, African Americans, ethnology, psychology, Aged, Decision Making, Diabetes Mellitus, epidemiology, therapy, Female, Humans, Interviews as Topic, methods, Male, Middle Aged, Patient Education as Topic, Patient Participation, Physician-Patient Relations, Young Adult

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          Abstract

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

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