Ethnic group and gender influence patients' treatment decision-making

Ethnic group and gender both influence patients' experiences with treatment decision-making but in different ways, according to new research led by Henry S. Perkins, MD, of the University of Texas Health Science Center and the Ecumenical Center for Religion and Health in San Antonio, Texas. That conclusion appears in an article in the July issue of Medical Care, published in the Lippincott portfolio by Wolters Kluwer.

In earlier studies, the researchers found differences among American Hispanic, White, and Black patients' views on end-of-life planning. That prompted a reanalysis of the data looking at patients' preferences for treatment decision-making and perceptions of actual treatment decision-making.

Study patients were 58 adults (aged 50 to 79 years) hospitalized for serious medical conditions such as heart or lung diseases. Interviews asked patients' preferences and perceptions about involvement in decision-making, ranging from doctor-controlled decisions to shared decisions (either by doctor and patient jointly or by doctor alone and patient alone on separate occasions) to patient-controlled decisions.

Gender, but not ethnic group, indicated patients' decision-making preferences. Overall, 12 patients preferred doctor-controlled decisions; 31, one or the other kind of shared decision-making; and 15, patient-controlled decisions.

Yet across ethnic groups, most men preferred doctor-controlled decisions (with or without patient involvement) while most women preferred patient-controlled decisions (with or without doctor involvement). Dr. Perkins and colleagues speculate that men "may be resigned (or relieved) to have doctors make health care decisions for them" while women "may want considerable responsibility" for making their own health care decisions.

In contrast, ethnic group and gender together indicated decision-making perceptions. Many patients in every ethnic and gender group perceived decision-making by the doctor alone and the patient alone on separate occasions. But for Hispanics roughly equal numbers of men and women did so, for Whites more men than women did so, and for Blacks more women than men did so. Dr. Perkins and colleagues note that, unexpectedly, "no respondents perceived decision-making shared by doctor and patient jointly."

Furthermore, ethnic group, but not gender, indicated matches between patients' decision-making preferences and perceptions. Matches occurred twice as often for Whites than for Hispanics or Blacks.

Dr. Perkins and colleagues conclude that neither ethnic group nor gender exerts an overall dominant influence on patients' decision-making preferences and perceptions. Each factor plays a separate but equally important role.

"Whenever direct inquiries of patients fail," the researchers write, awareness of those separate roles "may indicate patients' current preferences and perceptions about involvement in decision-making." But they also warn that "matching those preferences and perceptions, especially for minority patients, remains difficult."