Race, ethnicity, and shared decision making for hyperlipidemia and hypertension treatment: the DECISIONS survey.
BACKGROUND
Racial/ethnic differences in shared decision making about cardiovascular risk-reduction therapy could affect health disparities.


OBJECTIVE
To investigate whether patient race/ethnicity is associated with experiences discussing cardiovascular risk-reduction therapy with health care providers.


METHODS
National sample of US adults identified by random-digit dialing.


METHODS
Cross-sectional survey conducted in November 2006 to May 2007.


METHODS
Among participants in the National Survey of Medical Decisions (DECISIONS), a nationally representative sample of English-speaking US adults aged 40 and older, the authors analyzed respondents who reported discussing hyperlipidemia or hypertension medications with a health care provider in the previous 2 years.


METHODS
In multivariate linear and logistic regressions adjusting for age, gender, income, insurance status, perceived health, and current therapy, they assessed the relation between race/ethnicity (black/Hispanic v. white) and decision making: knowledge, discussion of pros and cons of therapy, discussion of patient preference, who made the final decision, preferred involvement, and confidence in the decision.


RESULTS
Of respondents who discussed high cholesterol (N = 738) or hypertension (N = 745) medications, 88% were white, 9% black, and 4% Hispanic. Minorities had lower knowledge scores than whites for hyperlipidemia (42% v. 52%, difference -10% [95% confidence interval (CI): 15, -5], P < 0.001), but not for hypertension. For hyperlipidemia, minorities were more likely than whites to report that the health care provider made the final decision for treatment (31.7% v. 12.3% whites, difference 19.4% [95% CI: 6.9, 33.1%], P < 0.01); this was not true for hypertension.


CONCLUSIONS
Possible limitations include the small percentage of minorities in the sample and potential recall bias.


CONCLUSIONS
Minorities considering hyperlipidemia therapy may be less informed about and less involved in the final decision-making process.
Ratanawongsa
Neda
N
Division of General Internal Medicine and Center for Vulnerable Populations, San Francisco General Hospital, University of California, San Francisco, CA 94110, USA. ratanawongsan@medsfgh.ucsf.edu
Zikmund-Fisher
Brian J
BJ
Couper
Mick P
MP
Van Hoewyk
John
J
Powe
Neil R
NR
D000328:Adult; D001741:Black or African American; D000368:Aged; D003142:Communication; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D003657:Decision Making; D005006:Ethnicity; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D054624:Health Status Disparities; D006630:Hispanic or Latino; D006801:Humans; D006949:Hyperlipidemias / Q000208:ethnology* / Q000517:prevention & control; D006973:Hypertension / Q000208:ethnology* / Q000517:prevention & control; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010358:Patient Participation; D010817:Physician-Patient Relations; D044469:Racial Groups; D040242:Risk Reduction Behavior; D014481:United States; D044465:White People