Medical Decision-making in Hispanic Patients Suffering with Chronic Pain

April 25, 2011

Study finds differences between Hispanic and non-Hispanic white patients when it comes to medical decision-making and preferred sources of medical information.

Study finds differences between Hispanic and non-Hispanic white patients when it comes to medical decision-making and preferred sources of medical information.

According to the authors of “Medical Decision-making among Hispanics and non-Hispanic Whites with Chronic Back and Knee Pain,” published in BMC Musculoskeletal Disorders, Hispanic utilization of total hip and knee replacement in the United States “is as low as half that of non-Hispanic Whites,” rates which cannot be explained by “ethnic differences in prevalence of arthritis, health insurance status, income or geographic location.” The authors hypothesized that these differences in utilization may be attributable to “differences in the treatments that physicians recommend to Hispanic patients, and differences between Hispanic and non-Hispanic patients in their preferences for treatment.”

One solution to greater patient empowerment, a process referred to as “shared decision making” that “calls for patients to be offered descriptions of available treatment options and informed of the favorable and adverse outcomes associated with each one,” may face several obstacles when implemented with Hispanic patients, who may “may differ from non-Hispanic whites in the type of health information they seek, the extent of decision-making authority they wish to exercise and the role of religion and faith in decision-making.”

In light of this, the authors undertook to answer the following questions:

  • Do Hispanics obtain knowledge about treatment options in a fashion that is similar to Whites?
  • Do Hispanics prefer to defer important health care decisions to their physicians or to the advice of family and friends?
  • Do the answers to these questions differ according to socioeconomic indicators?

To answer these and other questions regarding Hispanic patients’ medical decision making process and treatment utilization, the authors recruited six focus groups for Hispanic and non-Hispanic White subjects with chronic back or knee pain. Prospective participants had received care at least twice in one year (2006) at Brigham and Women’s Hospital in Boston for back or knee pain. Patients were asked to self-identify their ethnicity and race and were stratified according to “vulnerability” based on education, income, and other socioeconomic factors as determined by zip code.

Participants were organized into six moderated focus groups that discussed patients’ “knowledge of treatment options; the treatment decision-making process; discussions between patients and physicians about treatments; preferences for information resources and for roles in the decision process; and attitudes about strong or invasive treatment.”

Analysis of the transcripts of the focus group discussion sessions enabled the authors to identify several main themes that were repeated across focus groups, including:

  • Importance of pain decision-making process regarding care — participants across all groups frequently expressed that “pain was the primary reason they sought care for their musculoskeletal problem” and voiced frustration with “pain and with treatments that did not manage pain adequately”
  • Importance of prior experience (both their own and those of friends and family) — the authors reported that Hispanic patients “made more statements indicating that fear of negative treatment outcomes inhibited them from seeking care” and were more likely to state that “adverse prior treatment experiences of friends and family made them less inclined to choose a particular treatment.”
  • Physician-patient relationship — Many Hispanic patients stated that they viewed the physician as the primary decision maker in treatment decisions
  • Source of medical information — Physicians were the preferred source of medical information for all focus groups, with non-Hispanic whites and “less vulnerable” Hispanics also saying that “the internet was an important source of health information.”

In their discussion of these results, the authors wrote that their research “highlighted several important differences between Hispanics and non-Hispanic Whites in regard to health-related decision-making.” Hispanic patients were more likely to “be influenced by word-of-mouth communication of bad experiences with certain treatments, making them disinclined to seek or choose those treatments,” and were more likely “to comment on strategies for coping with musculoskeletal problems including a positive outlook, faith, religion, and family support.” Hispanic patients were

The authors also identified several commonalities that cut across ethnicity and socioeconomic status, including the central experience of pain and functional limitation that characterizes chronic back and knee conditions.

These findings “have implications for efforts to improve preference-based decision making;” for example, the authors suggest that because word-of-mouth is a “powerful source of information among Hispanics,” physicians’ decision support efforts “should target this potential source of misinformation.” They also suggest integrating religion, family, and faith as potential sources of support in Hispanic patients’ decision-making process. They also note that less-acculturated Hispanics “are much less likely to respond to internet-based strategies for providing health information.”

The information and data identified during this study led the authors to conclude that “Hispanic patients with knee and back pain appear to differ from non-Hispanic Whites in areas pertinent to shared decision-making, including the role of adverse experiences in shaping treatment preferences, the importance of family and religion in the decision process, and preferences for use of internet sources of health information as the foundation for health decisions. These findings should be confirmed, as they may help to shape strategies for refining the health-related decision-making process among Hispanics.”