Improving Shared Decision Making For Asian American Pacific Islander Sexual and Gender Minorities

Abstract

Background: Asian American Pacific Islander (AAPI) sexual and gender minorities (SGM) face unique challenges in mental health and accessing high-quality health care. Objective: The objective of this study was to identify barriers and facilitators for shared decision making (SDM) between AAPI SGM and providers, especially surrounding mental health. Research Design: Interviews, focus groups, and surveys. Subjects: AAPI SGM interviewees in Chicago (n=20) and San Francisco (n=20). Two focus groups (n=10) in San Francisco. Measures: Participants were asked open-ended questions about their health care experiences and how their identities impacted these encounters. Follow-up probes explored SDM and mental health. Participants were also surveyed about attitudes towards SGM disclosure and preferences about providers. Transcripts were analyzed for themes and a conceptual model was developed. Results: Our conceptual model elucidates the patient, provider, and encounter-centered factors that feed into SDM for AAPI SGM. Some participants shared the stigma of SGM identities and mental health in their AAPI families. Their AAPI and SGM identities were intertwined in affecting mental health. Some providers inappropriately controlled the visibility of the patient’s identities, ignoring or overemphasizing them. Participants varied on whether they preferred a provider of the same race, and how prominently their AAPI and/or SGM identities affected SDM. Conclusions: Providers should understand identity-specific challenges for AAPI SGM to engage in SDM. Providers should self-educate about AAPI and SGM history and intracommunity heterogeneity before the encounter, create a safe environment conducive to patient disclosure of SGM identity, and ask questions about patient priorities for the visit, pronouns, and mental health.

Patients’ and physicians’ gender and perspective on shared decision-making: A cross-sectional study from Dubai

“…This is especially true for value-based health care [ 2 ], where the main aspect of patient-centered care entails active engagement of the patients in their own healthcare decision making process, which is also known as shared decision making (SDM) [ 1 , 3 ]. SDM constitutes three domains: information-sharing between patients and providers, deliberation about the advantages and disadvantages of treatment options, and decision-making about a treatment plan that is approved by both the patient and the physician [ 4 , 5 ]. In this model of patient-provider communication, both patients and providers bring their own experiences, health literacy, and identities to the encounter, with variable levels of discordance [ 4 ].…”

“…SDM constitutes three domains: information-sharing between patients and providers, deliberation about the advantages and disadvantages of treatment options, and decision-making about a treatment plan that is approved by both the patient and the physician [ 4 , 5 ]. In this model of patient-provider communication, both patients and providers bring their own experiences, health literacy, and identities to the encounter, with variable levels of discordance [ 4 ].…”

Childbearing at the margins: A systematic metasynthesis of sexual and gender diverse childbearing experiences

“…A person‐centered and trauma‐informed care approach may bolster autonomy while dismantling structural invisibility and heterocisnormativity within health care 43,63 and reducing adverse mental health outcomes 64,65 . This approach also promises to repair distrust between the SGD community and the health care field generally 66 as childbearing serves as a specific time to reestablish regular health care services with SGD patients—who often disengage from medical care because of past experiences of discrimination—which could have a positive effect on health outcomes later in life.…”

Queering health services research

“…For example, most include minority stress theory as an explanation for gender-and sexual orientation-related health inequities. [18][19][20][21][22][23][24] A few also point toward the influence of structural determinants, such as homophobia and transphobia, as important explanations for the existence of…”

“…Six articles in Medical Care clearly focus on the intersections of identities as important in explaining LGBTQ+ health inequities. [19][20][21][22][23][24] However, few studies examine the mechanisms through which interlocking structural determinants, such as cisheterosexism and racism, shape health and health care experiences.…”