Shared decision making with ethnic minorities in oncology: An interview study

This study aims to 1) explore experiences of ethnic minority patients and their relatives regarding shared decision making (SDM) in oncological hospital care, alongside healthcare professionals' (HCPs) experiences of engaging in SDM with ethnic minority patients; 2) identify opportunities to improve SDM for ethnic minorities in oncology, if needed, by linking the findings to a previously developed value structure.

For this purpose, we interviewed ethnic minority patients (n = 22), relatives (n = 11), and HCPs (n = 14). Using reflexive thematic analysis, we applied Schwartz's value theory, adapted to the context of SDM, to code and analyze the interviews.

From the data, we developed three themes: 1) Factors that empower(ed) and disempower(ed) patients in SDM. Knowledge, skills, and competences of both HCP and patient [i.e. Achievement], support [i.e. Benevolence], and a good HCP-patient relationship [i.e. Security] empower patients. A lack of these three disempowers them; 2) Individualizing treatment decisions. Participants individualized treatment decisions through deliberation, negotiation, and choosing; 3) HCPs' limited insight into patients' context. HCPs experienced this due to a lack of cultural competences and perceived cultural differences.

SDM for ethnic minorities can be enhanced by strengthening HCPs' cultural competencies, increasing the availability of culturally and linguistically tailored information and support, and fostering ongoing relationship-building efforts. These strategies empower patients, enhance HCPs' insight into ethnic minority patients' context, and contribute to more individualized treatment decisions.

We recommend educational programs to increase HCPs' cultural sensitivity in SDM, developing campaigns to focus more on the needs of ethnic minority populations, and incorporating culturally and linguistically tailored support within hospital systems. Importantly, efforts should avoid overemphasizing cultural differences, as many empowering and disempowering factors also apply to the general population, but should be responsive to cultural aspects where relevant.