Association of Patient-Provider Race/Ethnicity Concordance and Patient-Reported Shared Decision Making Among US Adults: A National Study, 2015-2021.

Abstract

Shared decision making (SDM) is central to ethical, patient-centered care and has been linked to improved patient outcomes. Racial/ethnic disparities in SDM may contribute to health outcome inequities. The relationship between patient-provider race/ethnicity concordance and patient perceptions of SDM in routine care is less well known. To examine the association between patient-provider race/ethnicity concordance and patient-perceived SDM among a nationally representative sample of US adults. Cross-sectional analysis of nationally representative Medical Expenditure Panel Survey data 2015-2021. Adults (≥ 18 years, N = 23,790) from the Medical Expenditure Panel Survey (2015-2021; excluding 2018 and 2020 that did not include all SDM questions), who reported having a person (rather than a clinic or group) as their usual source of care provider were included. The sample included Non-Hispanic White (NHW; n = 15,738), Non-Hispanic Black (NHB; n = 3337), Hispanic (n = 3352), and Non-Hispanic Asian (NHA; n = 1363) respondents. The primary exposure was patient-provider race/ethnicity concordance, as measured by respondents' self-identified race/ethnicity and perceived race/ethnicity for their provider. The primary outcome was patient-reported SDM as measured by seven question items and dichotomized to high vs. low scores. Multivariable logistic regressions controlled for patient-level (sociodemographic, language, country of birth, and perceived health status), provider-level (gender, provider type), census region, and survey year fixed effects. Overall, 29.4% of the sample reported high SDM. Race/ethnicity concordance was positively associated with patient perception of high SDM among NHB (adjusted odds ratio [aOR], 1.23; 95% CI, 1.03-1.47) and NHW adults (aOR, 1.20; 95% CI, 1.09-1.32). No significant associations were observed for NHA and Hispanic adults. Patient-provider race/ethnicity concordance was significantly associated with improved patient perception of SDM quality among NHW and NHB adults. Findings highlight the importance of addressing structural and interpersonal factors to foster effective and equitable SDM experiences among diverse populations.