Abstract
Shared decision-making (SDM) is a process through which patients and providers collaborate to select a treatment option that aligns with patients' preferences and clinical context. SDM can improve patients' decision quality and satisfaction. However, vulnerable populations face barriers to participation in SDM, which exacerbates disparities in decision quality. This perspective article discusses SDM with vulnerable patients, using examples from patients who made decisions about postmastectomy breast reconstruction. We offer several strategies for clinical practice, medical education, and research to ensure that movements to engage patients in SDM do not exclude already marginalized groups.
Highlights
I thought [only] people in Hollywood had reconstructed breasts
We offer some strategies for future research and clinical training to ensure that movements to engage patients in Shared decision-making (SDM) do not exclude already marginalized groups
Supplementing conversations with decision tools can help address information gaps, but tools to support SDM are often not developed with specific attention to the needs of vulnerable populations.[20]
Summary
I thought [only] people in Hollywood had reconstructed breasts. I was a poor, old, Black lady, and it didn’t matter whether I had one breast. Supplementing conversations with decision tools can help address information gaps, but tools to support SDM are often not developed with specific attention to the needs of vulnerable populations.[20] In addition, educational materials may not communicate information in ways that facilitate comprehension, such as using icon arrays to present risk.[21] One patient in our study was left with an incomplete understanding of surgical risks after reading complicated educational materials.
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