April 19, 2004

Study examines blacks' medical decision-making

By Alicia Sands Lurry


Making important medical decisions can be a daunting task for almost anyone. Yet for some African American patients, concerns about their health, their own understanding of certain procedures and the recommendation of their health care provider are the most important factors when making such decisions, according to a study published in the March 8 issue of Archives of Internal Medicine.

Lead author Alexia Torke, assistant professor of medicine and internist at Grady Hospital, and her coauthors interviewed 25 African American patients over 50 who had discussed flexible sigmoidoscopy (a test that screens for colon cancer) with their primary care provider.

Since medical literature offers little guidance, the authors sought to describe the perspectives of older African American patients in a primary clinic as they considered a medical decision. Qualitative interviews took place between Aug. 13 and Nov. 19, 1999, in the general medicine continuity clinic at Grady. Eighty-nine percent of Grady patients are African American, and many are uninsured or underinsured.

Patients were asked questions like: What were the most important factors you were considering in making the decision to have this test? Can you tell me how the decision about flexible sigmoidoscopy was actually made between you and your physician? How do you feel about patients receiving detailed information about the risks of a test/procedure? If your physician wanted you to have a test but you did not want to go ahead with it, would you feel comfortable saying no? Why or why not?

Patients also were asked: What kinds of things should a physician do to build trust with his or her patients?

"We wanted to know in the patients' own words what they were thinking about as they made decisions," Torke said. "This was a qualitative research project, so we were able to be very open-ended. The advantage of doing a qualitative project is that if we, as researchers, choose all the variables, initially we might miss things that are valuable to our patients.

"Oftentimes," she continued, "qualitative research is a good way to start out a research project when you don't really know what's going to be important to a group of people. It allows the patients to describe things in their own words."

Researchers found that Grady patients who considered flexible sigmoidoscopy often were concerned about cancer, the risks and benefits of the test, and whether it would be painful. Patients also considered the recommendation of their doctor or health care provider to be very important. In fact, when patients were asked if they wanted their health care provider to be involved in the decision, most people said they wanted their provider to either make the decision for them or at least help them make it.

"Another thing we found is that patients really want all the information about the tests and procedures," Torke said. "This is really similar to what other researchers have found, which is that people want to know all about the test they're going to get--but they don't necessarily want to be the one to make the decision."

William Branch, Carter Smith Sr. Professor of General Medicine and division director of general medicine at Grady, was coauthor of the paper; he and Torke were joined by Giselle Corbie-Smith of the University of North Carolina at Chapel Hill.