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Racial Disparity in Cardiac Decision Making
Results From Patient Focus Groups
Jeffrey A. Ferguson, MD, MPH;
Morris Weinberger, PhD;
Glenda R. Westmoreland, MD, MPH;
Lorrie A. Mamlin, MPH;
Douglas S. Segar, MD;
James Y. Greene, PhD;
Douglas K. Martin, MD;
William M. Tierney, MD
Arch Intern Med. 1998;158:1450-1453.
Background While numerous studies suggest that African Americans receive fewer invasive cardiac procedures than whites, the basis for these treatment differences is not understood.
Methods We conducted focus group sessions with patients who had received treatment in the hospital or the emergency department within the preceding 3 months for ischemic heart disease at 2 urban, university-affiliated hospitals.
Results Discussions with patients identified the following factors that influenced their decision making: clarity, simplicity, and consistency of treatment recommendations; advice from friends and family about whether to accept recommendations; availability to speak with others who accepted similar recommendations; and having honest and caring physicians. African American patients identified the following additional factors that influenced their decision making: perceptions of health care discrimination; perceptions of undesirable physician behavior; faith in God to control one's destiny; and patient-physician camaraderie.
Conclusions Participants identified common issues influencing health care decision making, regardless of race. However, additional factors were expressed only by African American participants. These factors conveyed racial differences in perceptions of the health care system that may, in part, contribute to differences in health care decision making and treatment.
From the Center for Health Services Research, Roudebush Veterans Affairs Medical Center (Drs Ferguson, Weinberger, Martin, and Tierney and Ms Mamlin), the Divisions of General Internal Medicine (Drs Ferguson, Weinberger, Westmoreland, Martin, and Tierney and Ms Mamlin) and Cardiology (Dr Segar), and the Department of Medicine (Dr Greene), Indiana University School of Medicine, and Regenstrief Institute for Health Care (Drs Weinberger, Westmoreland, and Tierney), Indianapolis, Ind.
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