Shared decision making (SDM) may narrow health equity gaps by engaging clients with their health care providers in decision making; little is known about SDM interventions with Aboriginal people. This study describes the health decision-making experiences of Aboriginal women by identifying decision needs, supports, and barriers. An interpretive descriptive qualitative study was conducted from January to June 2013 with an advisory group using a mutually developed ethical framework, participatory research principles, and postcolonial theory. Aboriginal women at Minwaashin Lodge were interviewed in semi-structured interviews and transcripts were coded using thematic analysis. Participants were 13 women between 20 and 70 years of age, and of Inuit, Métis, or First Nations descent. SDM needs and supports are represented by themes focused on relational features of SDM, and presented in a Medicine Wheel framework. Findings indicate that to be relevant for Aboriginal women, SDM tools and approaches may need to be adapted, and participatory approaches must be used.
AldenD. L., FriendJ., SchapiraM., & StiggleboutA. (2014). Cultural targeting and tailoring of shared decision making technology: A theoretical framework for improving the effectiveness of patient decision aids in culturally diverse groups.Social Science and Medicine, 105, 1–8.
2.
AndersonJ. M. (2002). Towards a post-colonial feminist methodology in nursing research exploring the convergence of post-colonial and feminist scholarship.Nurse Researcher, 9(3), 7–20.
3.
BattisteM. (2000). Introduction: Unfolding the lessons of colonization. In BattisteM. (Ed.), Reclaiming indigenous voice and vision (pp. xvi–xxix). Vancouver, Canada: University of British Columbia Press.
4.
BrascoupéS., & WatersC. (2009). Cultural safety—Exploring the applicability of the concept of cultural safety to Aboriginal health and community wellness.Journal of Aboriginal Health, 5(2), 6–41.
Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, & Social Sciences and Humanities Research Council of Canada. (2014). Tri-council policy statement: Ethical conduct for research involving humans, 2014. Retrieved from http://www.pre.ethics.gc.ca/pdf/eng/tcps2-2014/TCPS_2_FINAL_Web.pdf
7.
CharlesC., GafniA., & WhelanT. (1997). Shared decision-making in the medical encounter: What does it mean? (Or, it takes at least two to tango).Social Science and Medicine, 44(5), 681–692.
8.
DurandM. A., CarpenterL., DolanH., BravoP., MannM., BunnF., & ElwynG. (2014). Do interventions designed to support shared decision-making reduce health inequalities? A systematic review and meta-analysis.PLoS One, 9(4), e94670. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3988077/
9.
DureyA., WynadenD., ThompsonS. C., DavidsonP. M., BessarabD., & KatzenellenbogenJ. M. (2012). Owning solutions: A collaborative model to improve quality in hospital care for Aboriginal Australians.Nursing Inquiry, 19(2), 144–152.
10.
EastonP., EntwistleV. A., & WilliamsB. (2013). How the stigma of low literacy can impair patient-professional spoken interactions and affect health: Insights from a qualitative investigation.BMC Health Services Research, 13, 319. doi:10.1186/1472-6963-13-319
11.
EntwistleV., PriorM., SkeaZ. C., & FrancisJ. J. (2007). Involvement in treatment decision-making: Its meaning to people with diabetes and implications for conceptualization.Social Sciences and Medicine, 66(2), 362–375. doi:10.1016/j.socscimed.2007.09.001
12.
EntwistleV. A., & WattI. S. (2006). Patient involvement in treatment decision-making: The case for a broader conceptual framework.Patient Education and Counseling, 63(3), 268–278. doi:10.1016/j.pec.2006.05.002
13.
First Nations Centre. (2007). OCAP: Ownership, control, access and possession. Sanctioned by the First Nations Information Governance Committee.Ottawa, Canada: National Aboriginal Health Organization.
FroschD. L., LegareF., & MangioneC. M. (2008). Using decision aids in community based primary care: A theory driven evaluation with ethnically diverse patients.Patient Education and Counseling, 73(3), 490–496. doi:10.1016/j.pec.2008.07.040
16.
GrahamH., & LeesebergL. (2010). Contemporary perceptions of health from an indigenous (Plains Cree) perspective.Journal of Aboriginal Health, 6(1), 6–17.
17.
HalsethR. (2013). Aboriginal women in Canada: Gender, socio-economic determinants of health, and initiatives to close the wellness gap.Prince George, Canada: National Collaborating Centre for Aboriginal Health.
18.
HibbardJ. H., & GreenJ. (2013). What the evidence shows about patient activation: Better health outcomes and care experiences; fewer data on costs.Health Affairs, 32(2), 207–214.
19.
HubermanA. M., & MilesM. B. (1994). Qualitative data analysis: An expanded sourcebook (2nd ed.). Thousand Oaks, CA: Sage.
20.
Joseph-WilliamsN., ElwynG., & EdwardsA. (2014). Knowledge is not power for patients: A systematic review and thematic synthesis of patient-reported barriers and facilitators to shared decision making.Patient Education and Counselling, 94(3), 291–301.
21.
JullJ., CrispoJ., WelchV., MacDonaldH., BrascoupeS., BoyerY., & StaceyD. (2013). Interventions for indigenous peoples making health decisions: A systematic review.Pimatisiwin: A Journal of Aboriginal and Indigenous Community Health, 11(3), 539–554. Retrieved from http://www.pimatisiwin.com/online/?page_id=1288
22.
JullJ., GilesA., BoyerY., StaceyD., & LodgeMinwaashin (2015). Cultural adaptation of a shared decision making tool with Aboriginal women: A qualitative study.BMC Medical Informatics & Decision Making, 15(1). doi:10.1186/s12911-015-0129-7
23.
JullJ., StaceyD., GilesA., BoyerY., & LodgeMinwaashin (2012). Shared decision-making and health for First Nations, Métis and Inuit women: A study protocol.BMC Medical Informatics & Decision Making, 12, 146. doi:10.1186/1472-6947-12-146
24.
KellyK., DudgeonP., GeeG., & GlaskinB. (2009). Living on the edge: Social and emotional wellbeing and risk and protective factors for serious psychological distress among Aboriginal and Torres Strait Islander people. Discussion Paper No. 10. Retrieved from https://www.lowitja.org.au/sites/default/files/docs/DP%2010_web_0.pdf
25.
KieslerD. J., & AuerbachA. M. (2006). Optimal matches of patient preferences for information, decision-making and interpersonal behavior: Evidence, models and interventions.Patient Education and Counseling, 61(3), 319–341. doi:10.1016/j.pec.2005.08.002
26.
KruskeS., KildeaS., & BarclayL. (2006). Cultural safety and maternity care for Aboriginal and Torres Strait Islanders.Women and Birth, 19(3), 73–77.
27.
MacDonaldC. (2008). Using components of the Medicine Wheel to develop a conceptual framework for understanding Aboriginal women in the context of pap smear screening.Pimatisiwin: A Journal of Aboriginal and Indigenous Community Health, 6(3), 95–108.
28.
MakoulG., & ClaymanM. L. (2006). An integrative model of shared decision making in clinical encounters.Patient Education and Counselling, 60(3), 301–312.
29.
McCafferyK., Holmes-RovnerM., SmithS. K., RovnerD., NutbeamD., ClaymanM., … SheridanS. l. (2013). Addressing health literacy in patient decision aids.BMC Medical Informatics & Decision Making, 13(Suppl. 2), S10. Retrieved from http://www.biomedcentral.com/1472-6947/13/S2/S10
30.
McEwanC. (2009). Postcolonialism and development.New York, NY: Routledge.
31.
MeadE. L., DoorenbosA. Z., JavidS. H., HaozousE. A., AlvordL. A., FlumD. R., & MorrisA. M. (2013). Shared decision-making for cancer care among racial and ethnic minorities: A systematic review.American Journal of Public Health, 103(12), e15–e29. doi: 10.2105/AJPH.2013.301631
32.
MitraD., JacobsenM. J., O'ConnorA., PottieK., & TugwellP. (2006). Assessment of the decision support needs of women from HIV endemic countries regarding voluntary HIV testing in Canada.Patient Education & Counseling, 63(3), 292–300.
33.
National Aboriginal Health Organization. (2008). Cultural competency and safety: A guide for health care administrators, providers, and educators.Ottawa, Canada: Author.
Native Women's Association of Canada. (2009). Violence against Aboriginal women in Canada (backgrounder).Ottawa, Canada: Author.
37.
NutbeamD. (2000). Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21st century.Health Promotion International, 15(3), 259–267.
PfeifferD. (2001). The conceptualization of disability. In BarnarttS. N., & Mandell AltmanB. (Eds.), Research in social science and disability (pp. 29–52). New York, NY: Elsevier Science.
40.
Public Health Agency of Canada. (2003). Canadian incidence study of reported child abuse and neglect, 2003: Major findings.Ottawa, Canada: Minister of Public Works and Government Services Canada.
41.
Reimer-KirkhamS., & AndersonJ. (2002). Postcolonial nursing scholarship: From epistemology to method.Advances in Nursing Science, 25(1), 1–17.
SankhulaniL. (2007). Gender issues in Aboriginal learning.Saskatoon, Canada: Canadian Council on Learning.
44.
StaceyD., KryworuchkoJ., BennettC., MurrayM. A., MullanS., & LégaréF. (2012). Decision coaching to help prepare patients for making health decisions: A systematic review of decision coaching in trials of patient decision aids.Medical Decision Making, 32(3), E22–E33.
45.
StaceyD., LégaréF., ColN. F., BennettC. L., BarryM. J., EdenK. B., … WuJ. H. (2014). Decision aids for people facing health treatment or screening decisions.Cochrane Database of Systematic Reviews, 2014(1), 1–265. doi:10.1002/14651858.CD001431.pub4
