Collins TC, Clark JA, Petersen LA, Kressin NR.
Racial differences in how patients perceive physician communication
regarding cardiac testing.
Med Care 2002 Jan;40(1 Suppl):I27-34.
The data on racial disparities in use of cardiac procedures--which cannot
be explained by access to care or disease severity-- has lead to speculation
about racial differences in attitudes toward treatment. The authors explored
racial differences in patient attitudes and how patients perceive information
delivery from physicians as decisions are made regarding the use of cardiac
procedures.
The study sample included patients from the Houston Veterans Affairs
Medical Center who had undergone cardiac stress tests with positive findings
in the previous 12 months (dates not given). A white medical sociologist
and a black general internist conducted focus groups to elicit patients'
accounts of their experiences with cardiac stress testing and their decisions
regarding invasive procedures. Of 89 eligible patients, only 13 participated
in the focus groups. Four groups were established: black men having undergone
only stress testing (N=3), white men having undergone only stress testing
(N=4), white men with stress testing alone or stress testing with further
procedures (N=3), black men with stress testing alone or stress testing
with further procedures (N=3).
Analyses (conducted by researcher familiar with the goals of the study)
identified four major issues relating to patient communication with providers
that appeared to bear on whether they underwent additional invasive cardiac
tests after the initial finding of abnormality on the stress test:
1. The test results as they were presented to both black and white patients
were often vague and confusing.
2. Black and white patients with previous traumatic experiences varying
from pain to cardiac arrests appeared less likely to accept the recommendation
for a subsequent health catheterization.
3. White patients expressed a need to be convinced to undergo procedures.
4. Black patients expressed a need to trust the physician.
