Genders of patients and clinicians and their effect on shared decision making: a participant-level meta-analysis
1 Pediatric and Adolescent Medicine Residency Program, Department of Pediatrics, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
2 Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
3 Department of Health Sciences Research, Division of Health Care Policy and Research, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
4 Division of Cardiovascular Diseases, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
5 Division of Emergency Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
6 Division of Endocrinology, Diabetes, Metabolism, Nutrition, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
BMC Medical Informatics and Decision Making 2014, 14:81 doi:10.1186/1472-6947-14-81Published: 2 September 2014
Gender differences in communication styles between clinicians and patients have been postulated to impact patient care, but the extent to which the gender dyad structure impacts outcomes in shared decision making remains unclear.
Participant-level meta-analysis of 775 clinical encounters within 7 randomized trials where decision aids, shared decision making tools, were used at the point of care. Outcomes analysed include decisional conflict scale scores, satisfaction with the clinical encounter, concordance between stated decision and action taken, and degree of patient engagement by the clinician using the OPTION scale. An estimated minimal important difference was used to determine if nonsignificant results could be explained by low power.
We did not find a statistically significant interaction between clinician/patient gender mix and arm for decisional conflict, satisfaction with the clinical encounter or patient engagement. A borderline significant interaction (p = 0.05) was observed for one outcome: concordance between stated decision and action taken, where encounters with female clinician/male patient showed increased concordance in the decision aid arm compared to control (8% more concordant encounters). All other gender dyads showed decreased concordance with decision aid use (6% fewer concordant encounters for same-gender, 16% fewer concordant encounters for male clinician/female patient).
In this participant-level meta-analysis of 7 randomized trials, decision aids used at the point of care demonstrated comparable efficacy across gender dyads. Purported barriers to shared decision making based on gender were not detected when tested for a minimum detected difference.