Health Services Research & Development

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2006 HSR&D National Meeting Abstract


3023 — Racial Differences in Treatment Decision-Making among Veterans with Osteoarthritis

Author List:
Golightly YM (Center for Health Services Research in Primary Care)
Allen KD (Center for Health Services Research in Primary Care)
Bosworth HB (Center for Health Services Research in Primary Care)

Objectives:
This study examined racial differences in patient preferences for involvement in treatment decisions, as well as their perceptions of physicians’ participatory decision-making (PDM) style among veterans with osteoarthritis (OA).

Methods:
This was a cross-sectional survey among 197 veterans (African American 30% and Caucasian 70%) with OA at the Durham VAMC. Patients rated their preferred level of involvement in treatment decisions on a validated 5-point scale, which was dichotomized into patient/shared vs. physician directed. Physicians’ PDM style was measured as the aggregate of 3-items, which asked the patients to rate the likelihood of the physician to involve them in aspects of care. Chi-square and t-tests were used to compare these two variables according to race. Logistic and linear regression models examined racial differences while adjusting for age, OA severity, and income.

Results:
More participants preferred patient/shared decision-making (70.6%) than physician-directed decision-making (29.4%). Participants reported moderate levels of physician PDM (mean=20.1 (SD=8.1), scale of 3-30; higher scores = more patient involvement). There was no significant racial difference in the proportion of patients who preferred physician-directed decision-making (Caucasians: 31.9%, African Americans: 23.7%, p = 0.25). Similarly, there was no significant racial difference in mean level of physician PDM (Caucasians: 19.5 (SD=8.1), African Americans: 21.3 (SD=8.1), p= 0.24). In multivariable regression models, race was not significantly associated with either variable.

Implications:
Most previous research has shown that African Americans perceive their physician visits as less participatory than Caucasians. In contrast, this study found that within the equal-access VA health care system, there were no statistically significant racial differences in perceptions of physicians PDM style or patients’ treatment decision-making preferences. These results are very encouraging, but results also indicate that there is still room for some improvement in overall patient perceptions of involvement in treatment decisions.

Impacts:
Patient involvement in treatment decision-making can improve adherence and health outcomes. This study suggests that there are fewer racial disparities in PDM within the VA healthcare system than have been reported in other settings. The VA should strive to enhance overall patient involvement in decision-making in order to optimize care and patient satisfaction.