Genders of patients and clinicians and their effect on shared decision making: a participant-level meta-analysis

Kirk D Wyatt, Megan E Branda, Jonathan W Inselman, Henry H Ting, Erik P Hess, Victor M Montori, Annie LeBlanc, Kirk D Wyatt, Megan E Branda, Jonathan W Inselman, Henry H Ting, Erik P Hess, Victor M Montori, Annie LeBlanc

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

Trial registrations: ClinicalTrials.gov NCT00888537, NCT01077037, NCT01029288, NCT00388050, NCT00578981, NCT00949611, NCT00217061.

Figures

Figure 1
Figure 1
Effect of gender groupings on decisional conflict. Analysis separating the “same” gender group into male/male and female/female (not shown) made no change in the results. Footnote: Abbreviations: CL, clinician; PT, patient; MID, minimal important difference. Mean differences (DA – UC) calculated using simulation estimates from multilevel mixed-effects linear regression models for each arm within each gender mix. Mean differences were compared between gender mixes to test against MID.
Figure 2
Figure 2
Effect of gender groupings on knowledge and patient engagement (OPTION). Analysis separating the “same” gender group into male/male and female/female (not shown) made no change in the results. Footnote: Abbreviations: CL, clinician; PT, patient; MID, minimal important difference. Mean differences (DA – UC) calculated using simulation estimates from multilevel mixed-effects linear regression models for each arm within each gender mix. Mean differences were compared between gender mixes to test against MID.
Figure 3
Figure 3
Effect of gender groupings on patient satisfaction and concordance (agreement with decision). Analysis separating the “same” gender group into male/male and female/female (not shown) made no change in the results. Footnote/legend: Abbreviations: Clinician CL; Patient PT; minimal important difference, MID. Mean differences (DA – UC) calculated using simulation estimates from multilevel mixed-effects logistic regression models for each arm within each gender mix. Mean differences compared between gender mixes to test against MID.

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Source: PubMed

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