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Cited by 63Patient-Provider Communication in HealthcareEmergency and Acute Care StudiesCultural Competency in Health Care

Shared decision making with vulnerable populations in the emergency department

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Castaneda‐Guarderas, Ana, Glassberg, Jeffrey, Grudzen, Corita R., Ngai, Ka Ming, Samuels‐Kalow, Margaret E., Shelton, Erica, Wall, Stephen P., Richardson, Lynne D.·2016·Academic Emergency Medicine
DOI 10.1111/acem.13134PMC PMC9165457
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Abstract

The emergency department ( ED ) occupies a unique position within the healthcare system, serving as a safety net for vulnerable patients, regardless of their race, ethnicity, religion, country of origin, sexual orientation, socioeconomic status, or medical diagnosis. Shared decision making ( SDM ) presents special challenges when used with vulnerable population groups. The differing circumstances, needs, and perspectives of vulnerable groups invoke issues of provider bias, disrespect, judgmental attitudes, and lack of cultural competence, as well as patient mistrust and the consequences of their social and economic disenfranchisement. A research agenda that includes community‐engaged approaches, mixed‐methods studies, and cost‐effectiveness analyses is proposed to address the following questions: 1) What are the best processes/formats for SDM among racial, ethnic, cultural, religious, linguistic, social, or otherwise vulnerable groups who experience disadvantage in the healthcare system? 2) What organizational or systemic changes are needed to support SDM in the ED whenever appropriate? 3) What competencies are needed to enable emergency providers to consider patients’ situation/context in an unbiased way? 4) How do we teach these competencies to students and residents? 5) How do we cultivate these competencies in practicing emergency physicians, nurses, and other clinical providers who lack them? The authors also identify the importance of using accurate, group‐specific data to inform risk estimates for SDM decision aids for vulnerable populations and the need for increased ED ‐based care coordination and transitional care management capabilities to create additional care options that align with the needs and preferences of vulnerable populations.

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  • The perceived power differential between the HP and the patient can inhibit shared decision-making because it negatively effects patient trust.

    “Castaneda‐Guarderas et al 114 and Krupat et al 51 assert that the perceived power differential between the HP and the patient can inhibit shared decision-making because it negatively effects patient trust.114”

    From Health professionals implicit bias of patients with low socioeconomic status (SES) and its effects on clinical decision-making: a scoping review (2024) · cites this paper as [114]

    The Race and Ethnicity and Socioeconomic Disadvantage sections say that perceived power differentials can inhibit shared decision-making. They also link lower trust to difficulty with shared decision-making, but attribute damage to trust to provider bias or judgmental attitudes; they do not say that power differentials inhibit shared decision-making because they reduce trust. Page numbers are unavailable in our copy. (LLM, conf=0.84)

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Authors
Castaneda‐Guarderas, A., Glassberg, J., Grudzen, C. R., Ngai, K. M., Samuels‐Kalow, M. E., Shelton, E., Wall, S. P., & Richardson, L. D.
Affiliations
  • Department of Emergency Medicine Aventura Hospital and Medical Center Miami FL
  • Icahn School of Medicine at Mount Sinai (US)
  • New York University (US)
  • Massachusetts General Hospital (US)
  • Johns Hopkins University (US)
  • Bellevue Hospital Center (US)
Corresponding author
Richardson, Lynne D.
ORCID
Venue
Academic Emergency Medicine
Publisher
Wiley
Published
2016-12
Volume
23
Issue
12
Pages
1410-1416
ISSN
  • 1069-6563 (ISSN-L)
  • 1553-2712
DOI
10.1111/acem.13134
PMC
PMC9165457
OpenAlex
W2553867843
Cited by
63
References
6
Citations by year
2026: 5 · 2025: 12 · 2024: 14 · 2023: 8 · 2022: 6 · 2021: 5 · 2020: 6 · 2019: 3 · 2018: 3
FWCI
3.73
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 7 d)
Locations
  • Academic Emergency Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Agency for Healthcare Research and Quality (1R13HS024172‐01)
  • National Institute on Minority Health and Health Disparities (1R13MD010171‐01)
  • Patient-Centered Outcomes Research Institute (0876)
Topics
  • Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
  • Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
  • Social Sciences › Sociology and Political Science › Cultural Competency in Health Care
Keywords
shared decision-making, vulnerable populations, emergency department, cultural competence, provider bias, patient mistrust, social determinants of health, community-engaged research, decision aids, risk estimates, care coordination, care transitions, medical education
MeSH terms
Community Participation, Decision Making, Emergency Medicine, Emergency Service, Hospital, Health Services Research, Humans, Health Knowledge, Attitudes, Practice, Patient Participation, Socioeconomic Factors, Vulnerable Populations, Cultural Competency

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