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Review
. 2016 Jun;31(6):663-76.
doi: 10.1007/s11606-016-3609-2.

Use of Decision Aids with Minority Patients: a Systematic Review

Aviva G Nathan  1 , Imani M Marshall  2 , Jennifer M Cooper  2 , Elbert S Huang  2
Affiliations
Review

Use of Decision Aids with Minority Patients: a Systematic Review

Aviva G Nathan et al. J Gen Intern Med. 2016 Jun.

Abstract

Background: One potential approach to reducing health disparities among minorities is through the promotion of shared decision making (SDM). The most commonly studied SDM intervention is the decision aid (DA). While DAs have been extensively studied, we know relatively little about their use in minority populations. We conducted a systematic review to characterize the application and effectiveness of DAs in racial, ethnic, sexual, and gender minorities.

Methods: We searched PubMed for randomized controlled trials (RCTs) evaluating DAs between 2004 and 2013. We included trials that enrolled adults (> 18 years of age) with > 50 % representation by minority patients. Four reviewers independently assessed 597 initially identified articles, and those with inconclusive results were discussed to consensus. We abstracted decision quality, patient-doctor communication, and clinical treatment decision outcomes. Results were considered significantly modified by the DA if the study reported p < 0.05.

Results: We reviewed 18 RCTs of DA interventions in minority populations. The majority of interventions (78 %) addressed cancer screening. The most common mode of delivery for the DAs was personal counseling (46 %), followed by multi-media (29 %), and print materials (25 %). Most of the trials studied racial (78 %) or ethnic (17 %) minorities with only one trial focused on sexual minorities and none on gender minorities. Ten studies tailored their interventions for their minority populations. Comparing intervention vs. control, decision quality outcomes improved in six out of eight studies and patient-doctor communication improved in six out of seven studies. Of the 15 studies that reported on clinical decisions, eight demonstrated significant changes in decisions with DAs.

Discussion: DAs have been effective in improving patient-doctor communication and decision quality outcomes in minority populations and could help address health disparities. However, the existing literature is almost non-existent for sexual and gender minorities and has not included the full breadth of clinical decisions that affect minority populations.

Keywords: disparities; medical decision making; minority health; race and ethnicity; shared decision making; systematic reviews.

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Conflict of interest statement

Conflicts of Interest

The authors declare that they do not have a conflict of interest.

Funding

This project was supported by the Agency for Healthcare Research and Quality (1U18 HS023050) and the Robert Wood Johnson Foundation Finding Answers: Disparities Research for Change Program. Dr. Huang was also supported by the Chicago Center for Diabetes Translation Research (P30 DK092949) and a Midcareer Investigator Award in Patient-Oriented Research (K24 DK105340).

Figures

Figure 1.
Figure 1.
Flow diagram of study selection process for systematic review.
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