- Primary Investigator:
Jeffrey N. Katz - Primary Location:
Brigham and Women's Hospital - Grant Type & Year:
IIG 2006
Purpose
- Identify differences and similarities between Hispanics’ and non-Hispanic Whites’ understanding of key elements of the shared decision making process, barriers to SDM, knowledge about treatments, and about the risks and benefits of each option.
- Elicit suggestions for the most effective and culturally appropriate strategies and tools to facilitate shared decision making from the Hispanic and non-Hispanic patients.
- Identify provider-perceived facilitating factors and impediments for engaging Hispanic patients in a shared decision making process for preference-sensitive therapies.
Findings
Our findings suggest striking commonalities across the clinical conditions (back vs. knee), sociodemographic strata (high vs. low vulnerability) and ethnic groups (Hispanics vs. non-Hispanic whites). Experienced across anatomic, socioeconomic and ethnic strata, pain and functional limitation are the central experiences of these musculoskeletal disorders. In addition, across all strata, subjects stated that they are aware of the advantages and disadvantages of treatment options and that, in general, they trust their physicians. Subjects tended to give mixed reviews of the physicians’ manner and rapport, and provided largely negative assessments of the physicians’ office practice. Across all groups, subjects prefer receiving health information from physicians as compared with other print and electronic sources. In sum, a number of core elements of the illness experience and the doctor-patient relationship are shared across the different groups represented in our research.
Informative differences were found from the data as well. Hispanics were more likely to state that prior experiences, generally adverse, made them less inclined to seek care or to choose specific treatments. Those Hispanics in the “low vulnerability” group were more likely to view the physician as the primary decision maker compared to the “high vulnerability” Hispanics or Whites who saw themselves as the primary decision makers. The greater reliance on the physician among less vulnerable Hispanics (rather than more vulnerable) is somewhat unexpected and, therefore, merits further investigation. Hispanics were much more likely than Whites to comment on the use of strategies for coping with musculoskeletal problems and their treatments, including a positive outlook, faith and religion, and family support. Finally, the Internet served as a source of health information for Whites and ‘low vulnerability’ Hispanics, but not for ‘high vulnerability’ Hispanics.
