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My blog for health care providers using MI about the process of change!

Power-sharing and Racial/Ethnic Minority Patients

Give light and people will find the way. -Ella Baker
In February 2018, Alegria and colleagues from Massachusetts General Hospital published a randomized clinical trial with racial and ethnic minority patients to improve Shared Decision Making, a collaborative form of patient-patient communication that has been shown to improve treatment outcomes.

SDM overlaps with components of the “Spirit” of MI: partnership and emphasis on personal choice/autonomy. Both SDM and MI are very respectful of patients. The message is, “You are the expert on your experience. I trust that you already have the resources within you to solve your problem. My job is to walk down the path with you to help you discover it”. 
This is an empowering message for patients, and especially when working with racial and ethnic minority patients—a population that has historically felt powerless and mistrustful when interfacing with the health care system. Power-sharing can certainly increase patient trust and engagement.
The clinician intervention in the Alegria et al. (2018) trial included a workshop and coaching to promote communication and working alliance to promote SDM. Patients received a brief intervention sought to improve SDM and quality of care.
The clinician intervention improved SDM for racial/ethnic minority patients. This finding is consistent with one of the MI principles: clinicians can counsel with neutrality to strategically influence patient motivation/change—even when patients are reluctant to change. 
The patient intervention did not lead to increased SDM, however this just means clinicians might consider some structuring at the beginning of the session to orient patients to this style of helping.
The patient, across cultures, ultimately decides whether he/she wants to change or not. However, the collaborative atmosphere with emphasis on autonomy can reduce arguments against change, diffuse discord, increase the chances that change will happen. It is often our way of being that influences patients’ decision-making and helps to empower racial/ethnic minority patients in the change process.

Reference: Alegria, M., Nakash, O., Johnson, J., Ault-Brutus, A., Carson, N., Fillbrunn, M., Wang, Y., Cheng, A. Harris, T., Polo, A., Lincoln, A., Freeman, E., Bostdorf, B., Rosenbaum, M., Epelbaum, C., LaRoche, M., Okpokwasili-Johnson, E., Carrasco, M., & Shrout, P.E. (2018). Effectiveness of the DECIDE interventions on Shared Decision Making and perceived quality of care in behavioral health with multicultural patients: A randomized clinical trial. JAMA Psychiatry, Published online February 21, 2018.


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