title: Racial variation in treatment preferences and willingness to randomize in the Spine Patient Outcomes Research Trial (SPORT).
abstract: METHODS
  Analysis of baseline data for patients enrolled in Spine Patient Outcomes Research Trial (SPORT), a project conducting three randomized and three observational cohort studies of surgical and nonoperative treatments for intervertebral disc herniation (IDH), spinal stenosis (SpS), and degenerative spondylolisthesis (DS).
  
  
  OBJECTIVE
  To explore racial variation in treatment preferences and willingness to be randomized.
  
  
  BACKGROUND
  Increasing minority participation in research has been a priority at the NIH. Prior studies have documented lower rates of participation in research and preferences for invasive treatment among African-Americans.
  
  
  METHODS
  Patients enrolled in SPORT (March 2000 to February 2005) that reported data on their race (n = 2,323) were classified as White (87%), Black (8%), or Other (5%). Treatment preferences (nonoperative, unsure, surgical), and willingness to be randomized were compared among these groups while controlling for baseline differences using multivariate logistic regression. RESULTS.: There were numerous significant differences in baseline characteristics among the racial groups. Following adjustment for these differences, Blacks remained less likely to prefer surgical treatment among both IDH (White, 55%; Black, 37%; Other, 55%, P = 0.023) and SpS/DS (White, 46%; Black, 30%; Other, 43%; P = 0.017) patients. Higher randomization rates among Black IDH patients (46% vs. 30%) were no longer significant following adjustment (odds ratio [OR] = 1.45, P = 0.235). Treatment preference remained a strong independent predictor of randomization in multivariate analyses for both IDH (unsure OR = 3.88, P < 0.001 and surgical OR = 0.23, P < 0.001) and SpS/DS (unsure OR = 6.93, P < 0.001 and surgical OR = 0.45, P < 0.001) patients.
  
  
  CONCLUSIONS
  Similar to prior studies, Black participants were less likely than Whites or Others to prefer surgical treatment; however, they were no less likely to agree to be randomized. Treatment preferences were strongly related to both race and willingness to be randomized.
authors.affiliation: Dartmouth Medical School, Hanover, NH, USA.
authors.forename: Addisalem
authors.initials: A
authors.lastname: Arega
authors.forename: Nancy J O
authors.initials: NJ
authors.lastname: Birkmeyer
authors.forename: Jon D N
authors.initials: JD
authors.lastname: Lurie
authors.forename: Tor
authors.initials: T
authors.lastname: Tosteson
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gibson
authors.forename: Brett A
authors.initials: BA
authors.lastname: Taylor
authors.forename: Tamara Shawver
authors.initials: TS
authors.lastname: Morgan
authors.forename: James N
authors.initials: JN
authors.lastname: Weinstein
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology*; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D017060:Patient Satisfaction / Q000208:ethnology*; D044469:Racial Groups; D011897:Random Allocation; D016032:Randomized Controlled Trials as Topic / Q000523:psychology*; D013122:Spinal Diseases / Q000208:ethnology / Q000523:psychology* / Q000628:therapy; D044465:White People / Q000523:psychology