Racial disparity in cardiac decision making: results from patient focus groups.
BACKGROUND
While numerous studies suggest that African Americans receive fewer invasive cardiac procedures than whites, the basis for these treatment differences is not understood.


METHODS
We conducted focus group sessions with patients who had received treatment in the hospital or the emergency department within the preceding 3 months for ischemic heart disease at 2 urban, university-affiliated hospitals.


RESULTS
Discussions with patients identified the following factors that influenced their decision making: clarity, simplicity, and consistency of treatment recommendations; advice from friends and family about whether to accept recommendations; availability to speak with others who accepted similar recommendations; and having honest and caring physicians. African American patients identified the following additional factors that influenced their decision making: perceptions of health care discrimination; perceptions of undesirable physician behavior; faith in God to control one's destiny; and patient-physician camaraderie.


CONCLUSIONS
Participants identified common issues influencing health care decision making, regardless of race. However, additional factors were expressed only by African American participants. These factors conveyed racial differences in perceptions of the health care system that may, in part, contribute to differences in health care decision making and treatment.
Center for Health Services Research, Roudebush Veterans Affairs Medical Center, the Division of General Internal Medicine, Indiana University School of Medicine, Indianapolis 46202, USA.
J A
JA
Ferguson
M
M
Weinberger
G R
GR
Westmoreland
L A
LA
Mamlin
D S
DS
Segar
J Y
JY
Greene
D K
DK
Martin
W M
WM
Tierney
D001741:Black or African American / Q000706:statistics & numerical data*; D032882:Comprehension; D003657:Decision Making; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000208:ethnology*; D036301:Qualitative Research; D012106:Research; D035502:Trust; D014481:United States; D044465:White People / Q000706:statistics & numerical data*