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 medical decisions, according to an article published in the March 8 issue of Archives of Internal Medicine. The article's lead author is Alexia M. Torke, MD, assistant professor at the Emory University School of Medicine, and internist at Grady Memorial Hospital. Giselle Corbie-Smith, MD, of the University of North Carolina at Chapel Hill, and William Branch, MD, Carter Smith Senior Professor at Emory University School of Medicine and Division Director of General Medicine at Grady, are the co-authors.
The physicians interviewed 25 African American patients older than 50 years who had discussed flexible sigmoidoscopy, a test that screens for colon cancer, with their primary care provider. Since medical literature offers little information about how older African Americans view the medical decision-making process, the authors sought to describe the perspectives of older African American patients in a primary clinic as they consider a medical decision. Interviews took place between August 13, 1999 and November 19, 1999 in the general medicine continuity clinic at Grady Hospital in Atlanta. Eighty-nine percent of patients at Grady are African American. Many are uninsured or underinsured. Interviews were analyzed using qualitative methods.
Patients were asked questions like: What were the most important factors you were considering in making he 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 were also 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 the decision," Dr. Torke explains. "This was a qualitative research project, so we were able to be very open-ended and ask the patients to tell us in their own words what they think. 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, 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 healthcare 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 to make the decision together with them.
"Another thing we found is that patients really want all the information about the tests and procedures," Dr. 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. Yet one of the things that our study was able to point out that was unique is: 'Why is that so?' If people don't want to be the decision-maker, why do they want all of that information?'