Shared Decision Making & Patient Decision Aids in Diverse Patient Populations: Applying the Latest Innovations in Cultural Targeting and Tailoring in Your Health Care Practice

摘要

Culturally sensitive patient decision aids (DAs) play increasingly important roles in encouraging shared decision making (SDM) among patients with diverse value orientations. Drawing on a recently published paper (http://www.sciencedirect.com/science/article/pii/S0277953614000057), Professor Alden presented the advantages and challenges of cultural targeting and tailoring DAs. Incorporation of cultural psychology theories and measurement scales provided participants with a deeper understanding of how culture can be operationalized in the development of DAs. A model that emphasizes the interaction of culture, individual differences and context was offered to assist participants with production of their own health communication tools. Thereafter, two SDM interventions that used cultural targeting and tailoring in DA development were presented. The first case from Dr. Maria Jibaja-Weiss focused on “A Patchwork of Life: One Woman's Story” — a web-based, publicly available DA that addresses the cultural and linguistic needs of medically underserved women with early stage breast cancer and prepares them for making informed decisions (www.bcm.edu/patchworkoflife). It emphasizes the particular needs of ethnic women (Hispanic and African-American) in the United States with lower literacy and limited computer experience. The second case, presented by Dr. Chirk Jenn Ng, emphasized the importance of considering cultural values during the development of DAs in diverse multi-cultural settings such as Kuala Lumpur, Malaysia. The “Decision Making on Insulin Therapy (DMIT) DA” aims to enable patients with type 2 diabetes mellitus from diverse backgrounds to make informed decisions about starting insulin. The DA comes in booklet, iPad application and website versions and is available in four languages. Challenges faced during implementation of the DA reinforced the importance of considering the local healthcare culture, religion and health beliefs, family roles, and health-related myths (http://dmit.um.edu.my).