Photo Credit: Fizkes
Many patients with MS from underserved populations prefer shared decision making (SDM), and SDM is important to ensure equitable access to healthcare.
Shared decision-making (SDM) in medical care can only be successful if the patient participant is given enough background and understanding to engage in the process. Studies have found this essential when SDM is initiated in underserved populations.
Aliza Bitton Ben-Zacharia, PhD, DNP, and colleagues developed a systemic literature review of SDM’s application in underserved populations, focusing on patients with MS. The results were published in Multiple Sclerosis and Related Disorders.
Dr. Ben-Zacharia spoke with Physician’s Weekly (PW) regarding the findings and their applicability in practice.
PW: What prompted this research?
Dr. Ben-Zacharia: I was concerned that although we all talk about SDM, we are not preparing our diverse populations to participate and engage in it.
My main concern was that by doing this, we are further marginalizing populations that come from lower socioeconomic backgrounds and lower education. They would not be able to engage in SDM due to their lower education and other conditions. In addition, it is important to understand that SDM means that both the clinician and patients make the decisions. Patients would like to get the data from the experts and then make decisions in partnership while focusing on their values and preferences.
Which findings are important to emphasize?
The most important finding from our research/systematic review is that many patients with MS from underserved populations preferred SDM. In addition, SDM is important to ensure healthcare is accessible to underserved populations; it can positively impact the patient and their disease outcomes. Not utilizing SDM can lead to patient dissatisfaction, decisional regret, and a lack of confidence in the medical system.
How can they be incorporated into patient visits?
Clinicians and MS experts must know that marginalized populations have limited clout associated with their social identities, and they have been disproportionately less engaged in SDM than other groups with more social power. The medical team must educate underserved populations and avoid implicit bias. That is, they should not assume that people from underserved populations would not understand the MS research and data on the different treatments for the disease. We must educate and train clinicians using engagement activities while enhancing the importance of communicating with patients. Lastly, workshops and educational programs about SDM and health literacy could be provided to patients and clinicians to ensure optimal outcomes.
What makes this issue particularly urgent?
As clinicians and MS experts discuss SDM in our communities and MS centers, we must educate and train all patients about the data available in lay language to involve them in their care while making decisions with expert guidance. This is urgent because we cannot preach for SDM without the prep and education of underserved populations. If we do not pursue this in clinical practice, we will marginalize the underserved populations, and the only people who will engage in SDM will be those from higher socioeconomic backgrounds and higher education levels.
What should future research focus on?
Future research should include different educational interventions to help underserved populations engage in SDM. We must research a few interventions to promote participation and partnerships in the care of underserved populations.
Is there anything else you would like to mention?
Utilizing SDM is a positive approach that ensures all patient populations are at the center of the care. SDM could be enhanced by using decision tools to reduce stigma, increasing access to educational materials, and providing information to underserved patients while providing training and guidance for clinicians.
