Hispanic Patients' Role Preferences in Primary Care Treatment Decision Making

Abstract

Shared decision making is considered to be a crucial component of high quality and safe patient-centered primary care treatment. Hispanics are the fastest growing minority group in the United States and they experience substantial health disparities. The aim of this study was to examine the factors that correlate with Hispanics' decision role preferences for participation in treatment decision making with their primary care clinician. Hispanic patients (n=772) were recruited from five zip codes in the Washington Heights/Inwood community of New York City and survey data were collected via interview by bilingual community health workers in four New York-Presbyterian Ambulatory Care Network clinics. Data were analyzed using multinomial logistic regression to investigate the association between sociodemographic and health factors and role preference in primary care treatment decision making (passive, shared, active); passive role as the reference range. Most survey respondents preferred to participate in medical treatment decisions in a shared or active role (90%) and also had inadequate health literacy (95%). The odds of wanting to participate in decision making in a shared role with a primary care provider significantly increased with younger age (OR=0.98, 95% CI [0.96- 0.99], p =0.01), less than 21 years living in the United States (OR=0.48, 95% CI [0.27- 0.88], p =0.02), more adequate health literacy (Newest Vital Sign) (OR=.46, 95% CI [0.25- 0.83], p =0.01), better ability to understand health instructions, pamphlets or written health materials (OR=0.55, 95% CI [0.31- 0.99], p =0.05), and higher social role performance (OR=0.97, 95% CI [0.94- 0.99], p =0.04). Statistically significant odds for preference for an active role were higher education (OR=3.11, 95% CI [1.20- 8.04], p =.02), less than 21 years living in the United States (OR=0.37, 95% CI [0.19- 0.73], p =0.004), and younger age (OR=0.98, 95% CI [0.95- 0.99], p =0.02). However, the overall models demonstrated poor fit with study data explaining 10% -14% of the variation of the dependent variable. Understanding the factors that influence Hispanic patients' role preference in primary care treatment decisions is crucial to providing higher quality patient-centered care and to possibly reducing Hispanics' health disparities. Our analysis suggested a number of patient specific factors that should be used to inform future informatics, clinical and public health primary care interventions for Hispanic patients. In addition, our analysis also underscores the need for more theoretical and analytical research to further characterize the factors that contribute to Hispanic patients' role preference in primary care treatment decision making