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Patient centered care, shared decision making, underserved populations



  1. Baca-Dietz, Debbie DNP, AGNP-BC (Primary Care Provider)


Background: Shared decision making (SDM) is a collaborative approach to patient care that facilitates patient engagement in self-care by upholding the patient's values and perspectives. The Affordable Care Act (2010) offers provisions for using SDM in clinical practice to improve care outcomes; however, inconsistent evidence exists about the provider-patient satisfaction and effectiveness of using SDM in Federally Qualified Health Centers (FQHCs), which offer care predominantly to the underserved.


Purpose: This study assessed providers' and patients' knowledge and understanding of SDM in two FQHC in the Pacific Northwest.


Methodological orientation: Descriptive phenomenological approach guided the investigation. Data were gathered through in-person interviews. Interviews were analyzed using the method discussed by Colaizzi (1978).


Sample: A purposive sample of 13 providers and 6 patients.


Conclusions: Although providers and patients had divergent understandings of SDM, they highly valued this approach to care. An overarching theme "We use SDM as a Cornerstone of Patient Centered Care" and two subthemes: "We are partners in care" and "Being in the driver seat may not be comfortable but necessary" captured the providers' experiences. "They tell you what's up and we do it together" was a key theme that emerged from the patients' narratives. Several processes further described provider and patient experiences with SDM in the FQHC.


Implications for practice: Findings suggest that the use of SDM in FQHC contributes to provider and patient satisfaction and improved patient engagement in self-care. Providers should therefore strongly consider using SDM model when working with the underserved.