Heart disease is the leading cause of death in the United States and the leading cause of death for Whites, Blacks and Hispanics. Although well-established for diagnosis and treatment of coronary disease, the use of invasive cardiac procedures such as cardiac catheterization and coronary artery bypass graft surgery is lower in Blacks and Hispanics when compared to Whites. Numerous studies have examined racial and ethnic variations in health care; however, the etiologies of these variations remain poorly understood. Studies that have controlled for severity of illness and access to care have not explained racial or ethnic variations. The failure of prior studies to explain racial and ethnic variations in care highlights at least one hypothesis that is poorly studied. That is, variations in patients' willingness to undergo diagnostic or therapeutic procedures recommended by their physicians could account for racial/ethnic variations.
Our research program investigating patient behavior has the two hypotheses: 1) patients' ethnic/cultural belief systems influence their perception of coronary heart disease and its care; and 2) patients' perceptions of care influence their willingness to seek and/or accept treatment for coronary disease. The study has two objectives: 1) to develop a comprehensive list of the underlying determinants of White, Black and Hispanic patients' decisions to undergo or not to undergo cardiac procedures (CATH and CABG) using qualitative methods; and 2) to design and test a comprehensive checklist for examining racial/ethnic variation in willingness to undergo cardiac procedures.
Telephone and focus group interviews occurred during the first six quarters. Development and pilot testing of the checklist and rating scale occurred over the last four quarters. Patients potentially eligible for the study were identified in the exercise or CATH laboratories. Patients were informed of the option to participate by research assistants. Patients were eligible for inclusion in one of sixteen focus group interviews. Patients were selected for one of these focus groups according to the recommended procedure, willingness to undergo the procedure, and patient self-defined race/ethnicity.
Preliminary findings indicate that rates of outright patient refusal for a procedure recommended by their physician is less than 3-5 percent.
The study will provide important insight into understanding of patient decision-making. The study will provide insight into whether decision-making varies by race/ethnicity.
- Gordon H, Paterniti D, Wray N. Impact of patient refusal on racial/ethnic variation in the use of invasive cardiac procedures. Paper presented at: Society of General Internal Medicine Annual Meeting; 2002 May 1; Atlanta, GA.