title: Medical decision-making among Hispanics and non-Hispanic Whites with chronic back and knee pain: a qualitative study.
abstract: BACKGROUND
  Musculoskeletal disorders affect all racial and ethnic groups, including Hispanics. Because these disorders are not life-threatening, decision-making is generally preference-based. Little is known about whether Hispanics in the U.S. differ from non-Hispanic Whites with respect to key decision making preferences.
  
  
  METHODS
  We assembled six focus groups of Hispanic and non-Hispanic White patients with chronic back or knee pain at an urban medical center to discuss management of their conditions and the roles they preferred in medical decision-making. Hispanic groups were further stratified by socioeconomic status, using neighborhood characteristics as proxy measures. Discussions were led by a moderator, taped, transcribed and analyzed using a grounded theory approach.
  
  
  RESULTS
  The analysis revealed ethnic differences in several areas pertinent to medical decision-making. Specifically, Hispanic participants were more likely to permit their physician to take the predominant role in making health decisions. Also, Hispanics of lower socioeconomic status generally preferred to use non-internet sources of health information to make medical decisions and to rely on advice obtained by word of mouth. Hispanics emphasized the role of faith and religion in coping with musculoskeletal disability. The analysis also revealed broad areas of concordance across ethnic strata including the primary role that pain and achieving pain relief play in patients' experiences and decisions.
  
  
  CONCLUSIONS
  These findings suggest differences between Hispanics and non-Hispanic Whites in preferred information sources and decision-making roles. These findings are hypothesis-generating. If confirmed in further research, they may inform the development of interventions to enhance preference-based decision-making among Hispanics.
authors.affiliation: Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA. jnkatz@partners.org
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Katz
authors.forename: Nancy
authors.initials: N
authors.lastname: Lyons
authors.forename: Lisa S
authors.initials: LS
authors.lastname: Wolff
authors.forename: Jodie
authors.initials: J
authors.lastname: Silverman
authors.forename: Parastu
authors.initials: P
authors.lastname: Emrani
authors.forename: Holly L
authors.initials: HL
authors.lastname: Holt
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Corbett
authors.forename: Agustin
authors.initials: A
authors.lastname: Escalante
authors.forename: Elena
authors.initials: E
authors.lastname: Losina
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000208:ethnology* / Q000523:psychology / Q000628:therapy; D001900:Boston / Q000453:epidemiology; D002755:Choice Behavior; D002908:Chronic Disease; D003466:Cultural Characteristics; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006630:Hispanic or Latino / Q000523:psychology*; D006801:Humans; D057226:Information Seeking Behavior; D007717:Knee / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000208:ethnology* / Q000503:physiopathology / Q000523:psychology; D059408:Pain Management; D010147:Pain Measurement; D057240:Patient Preference / Q000208:ethnology*; D010819:Physician's Role; D010817:Physician-Patient Relations; D036301:Qualitative Research; D012959:Socioeconomic Factors; D044465:White People / Q000523:psychology*