Shared decision making in the safety net: where do we go from here?

Area of Science:

• Healthcare delivery research
• Patient-centered care
• Health equity

Background:

• Shared decision making (SDM) is crucial for collaborative clinical choices.
• Safety net clinics face unique resource and environmental challenges.
• SDM implementation in safety net settings is understudied.

Purpose of the Study:

• To explore the current state of SDM in safety net primary care.
• To identify barriers and facilitators for SDM in these settings.
• To gather clinician perspectives on improving SDM.

Main Methods:

• Convenience sample of 15 primary care clinicians (physicians and nurse practitioners) from safety net clinics.
• Data collection via a 9-item SDM questionnaire and semistructured interviews.
• Thematic analysis of interview transcripts and questionnaire data.

Main Results:

• Clinicians reported incomplete SDM, with only a minority thoroughly weighing treatment options with patients.
• Key barriers identified include time pressure, visit complexity, patient preferences, and resource limitations.
• All clinicians cited lack of time as a significant impediment to practicing SDM.

Conclusions:

• Efficient SDM interventions tailored for safety net environments are needed.
• Team care and enhanced patient engagement are vital for successful SDM implementation.
• Future research should focus on adapting SDM to safety net settings and its potential to reduce health disparities.