DECISION-MAKING AMONG CALD ADULTS WITH CHRONIC DISEASE: A SYSTEMATIC REVIEW OF BARRIERS, FACILITATORS, AND INTERVENTIONS

D MUSCAT¹, R KANAGARATNAM¹, H SHEPHERD¹, K SUD^2-4, K MCCAFFERY¹, A WEBSTER^1,4

¹ University of Sydney, School of Public Health, New South Wales, Australia; ² University of Sydney, Sydney Medical School, New South Wales, Australia; ³ Nepean Hospital, Department of Renal Medicine, New South Wales, Australia; ⁴ Westmead Hospital, Centre for Transplant and Renal Research,  New South Wales, Australia

Background: For adults with chronic kidney disease (CKD), a shared approach to healthcare decision-making is advocated as the ideal model, given that it can improve patient outcomes. Culturally- and linguistically-diverse (CALD) adults are less likely than others to engage in decision-making.

Aims: To understand the barriers and facilitators of shared decision-making (SDM) for CALD adults with chronic health conditions and explore how existing interventions and cultural frameworks can be adapted for CKD populations.

Methods: Systematic literature review conducted on 30^th November 2016 using MedLine, PubMed, Embase, Cochrane Central Register of Controlled Trials, CINAHL, Informit Online and PsycInfo. Duplicates were removed and articles screened for exclusion criteria (population and study type). Articles discussing barriers and facilitators to healthcare engagement for CALD groups or frameworks for greater cultural competency were eligible for inclusion, as were articles reporting interventions to improve SDM in the context of related chronic diseases (e.g. diabetes; cardiovascular disease). Findings were synthesised thematically.

Results: 1668 articles were located and screened. Of those included, most focussed on one of 5 CALD populations (African American, Mexican, Hispanic, South Asian, Chinese). Within CALD patient–provider interactions, barriers to SDM included language fluency and provider biases (e.g. assuming patient preferences based on culture). CALD patients often used their community as a knowledge source and culturally-specific health beliefs influenced decisions to seek care and treatment. Mistrust due to cultural discordance limited information exchange within encounters. Across disease contexts, few interventions existed to support CALD populations to participate in decision-making.

Conclusions: Although CALD groups experience barriers to SDM, few interventions exist to address these. Research has been confined to a limited number of cultural groups, with little work in CKD.