GENERAL | February 18, 2021

Spotlight on Vulnerable Populations: Using Patient Decision Aids to Promote Healthcare Equity

Reading Time: 3 minutes

Reading Time: 3 minutes

Patients should never feel they have received suboptimal care or were treated differently because of their race, ethnicity, or socioeconomic status. However, healthcare disparities are an ongoing reality for minority and underserved communities throughout the United States.

Findings from a 2019 report from the American Cancer Society revealed that although the overall cancer death rate declined by 27 percent from 1991 to 2016, socioeconomic disparities in cancer mortality actually widened. The COVID-19 pandemic has further illuminated the problem, with minority and low-income populations suffering disproportionate levels of infection and death.

While there is no single measure that will eliminate health disparities, the use of patient decision aids as part of the shared decision-making process can help diminish health inequalities.

Building Trust

For individuals in minority and low-income groups, a pervasive mistrust of the healthcare system exists because of a history of bias and unethical treatment. That mistrust has only grown due to issues with inequitable access to quality care.

Trust is paramount in provider-patient relationships. Sensing bias or being “talked down to” evokes a response of mistrust and feelings of being excluded from the medical decision-making process. This in turn can adversely affect access to individualized, quality care. Using patient-centric decision support tools can help marginalized patients feel like they are partners in the process and cultivate trust in their provider.

Removing Implicit Bias

Implicit bias is defined as bias or prejudice resulting from “the tendency to process information or unconscious associations and feelings, even when these are contrary to one’s conscious or declared beliefs.”

Research shows that implicit bias may perpetuate healthcare disparities among vulnerable patients. Provider biases and assumptions can impact which information is shared and how options are presented. Additionally, patients may feel that the health information presented is not representative or applicable to them.

Providers can eliminate implicit bias by introducing patient decision aids that are inclusive and help structure the conversation around discovering that patient’s individual values, concerns, and goals for medical treatment.

Incorporating Language and Cultural Differences

People from different cultural and religious backgrounds may have different values, beliefs about health and illness, and approaches to communication and decision making. It is crucial to recognize the cultural factors that may influence medical decision making.

Differences in language also impact access to healthcare and shared decision making. The most recent American Community Survey shows that there are at least 380 languages spoken in the United States. Research shows that patients with limited English proficiency are at risk for suboptimal care and rehospitalizations.

By utilizing patient decision aids that are specifically developed for specific cultural groups and languages, providers can promote shared decision making and healthcare equity.

Boosting Medical Decision-Making Confidence

Approximately 65 percent of the nearly 77 million Americans who struggle with low health literacy are minorities. Low literacy limits access to healthcare and inhibits the ability of patients to confidently communicate with their providers and engage in shared decision making.

Supplementing conversations with decision aids can improve patients’ confidence in the process if these educational resources facilitate comprehension. Decision support materials that use plain language and present information at accessible reading, numeracy, and health literacy levels can empower patients to engage confidently in shared decision making, ultimately decreasing health disparities.

Choosing the Right Decision Aid

Marginalized patient populations benefit from a patient-centered approach to shared decision making. Utilizing patient decision aids that are culturally and racially inclusive, address potential bias, and are designed at appropriate health literacy levels can empower minority and low-income patients to engage in medical decision making and help reduce disparities in healthcare access and delivery.

For more information on selecting and using patient decision aids, read these articles from the ACP Decisions blog:

ACP Decisions is a leading provider of certified decision aids in the country. Our decision aids are listed as a fundamental resource for patient education and engagement in the National Quality Partners Playbook™: Shared Decision Making in Healthcare. With a mission to empower patients, their families, and their caregivers to make informed medical decisions, our video library consists of 400 videos available in 20+ languages and is accessible via a user-friendly technology platform. Contact us today for more information!

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