873-P: "I Had Nobody to Represent Me"—How Patient Perceptions of Diabetes Health Care Providers' Age, Gender, and Ethnicity Impact Shared Decision-Making

Abstract

Background: When patients and clinicians establish diabetes care plans together, patients are more likely to successfully manage their diabetes. Although studies reveal diabetes healthcare provider (HCP) bias and healthcare inequities, the potential impact of patient perceptions of their diabetes HCP is unknown. We explored how patient perceptions of their diabetes HCP influences treatment plans and shared decision-making (SDM). Methods: Adult participants with diabetes receiving diabetes care at community sites, primary care, or specialty clinics were invited to participate in semi-structured 30- to 45-minute interviews. Interviews were conducted from Nov 2018 to Jan 2019. Responses were qualitatively analyzed with NVivo for emergent themes. Results: We conducted 28 interviews with participants aged 34-81. Participants were female (16), male (11), FtM (1), and white (9), black/Caribbean (11), Asian/South Asian (4), Middle Eastern (2) and Hispanic (2). We identified the following themes: 1) Hidden bias for stated preference of HCP ethnicity: While most participants stated no preference, we identified hidden preferences via cultural relatability as well as evidence of color blindness. 2) Impact of HCP characteristics on SDM: Participants felt junior HCPs had up-to-date knowledge, while others preferred senior HCPs’ clinical experience. HCP gender and ethnicity impacted SDM via relatability; participants who related to their HCP were more likely to engage in a care plan. 3) Other factors affecting HCP preference: Participants preferred HCPs who provided patient-centered care, characterized by individualized referrals, trusting relationships, and HCPs’ investment in patient success. Conclusion: Diabetes affects persons of all ages, genders, and ethnicities. Exploring how patient perceptions of HCPs inform shared decision-making offers insight into systemic barriers to equitable person-centered care. Disclosure T. Ahmad: None. S. Hari: None. D.E. Cleary: None. C. Yu: None.