Journal of Racial and Ethnic Health Disparities

, Volume 5, Issue 6, pp 1215–1229 | Cite as

Factors Related to Physician Clinical Decision-Making for African-American and Hispanic Patients: a Qualitative Meta-Synthesis

  • Khadijah BreathettEmail author
  • Jacqueline Jones
  • Hillary D. Lum
  • Dawn Koonkongsatian
  • Christine D. Jones
  • Urvi Sanghvi
  • Lilian Hoffecker
  • Marylyn McEwen
  • Stacie L. Daugherty
  • Irene V. Blair
  • Elizabeth Calhoun
  • Esther de Groot
  • Nancy K. Sweitzer
  • Pamela N. Peterson


Clinical decision-making may have a role in racial and ethnic disparities in healthcare but has not been evaluated systematically. The purpose of this study was to synthesize qualitative studies that explore various aspects of how a patient’s African-American race or Hispanic ethnicity may factor into physician clinical decision-making. Using Ovid MEDLINE, Embase, and Cochrane Library, we identified 13 manuscripts that met inclusion criteria of usage of qualitative methods; addressed US physician clinical decision-making factors when caring for African-American, Hispanic, or Caucasian patients; and published between 2000 and 2017. We derived six fundamental themes that detail the role of patient race and ethnicity on physician decision-making, including importance of race, patient-level issues, system-level issues, bias and racism, patient values, and communication. In conclusion, a non-hierarchical system of intertwining themes influenced clinical decision-making among racial and ethnic minority patients. Future study should systematically intervene upon each theme in order to promote equitable clinical decision-making among diverse racial/ethnic patients.


Clinical decision-making Healthcare disparities Minority health Bias 


Funding information

Dr. Breathett received support from the American Heart Association (AHA) Strategically Focused Research Network (no. 16SFRN29640000), the National Institute of Health (NIH L60 MD010857), the University of Colorado Department of Medicine, Health Services Research Development Grant Award, and the University of Arizona Health Sciences, Strategic Priorities Faculty Initiative Grant. Dr. Jones received support from the Agency for Healthcare Research and Quality (K08HS024569). Dr. Peterson discloses grant funding from the AHA. Otherwise there are no disclosures.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Not applicable. This was a retrospective study of previously published publicly available manuscripts.

Supplementary material

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Copyright information

© W. Montague Cobb-NMA Health Institute 2018

Authors and Affiliations

  • Khadijah Breathett
    • 1
    Email author
  • Jacqueline Jones
    • 2
  • Hillary D. Lum
    • 3
  • Dawn Koonkongsatian
    • 2
  • Christine D. Jones
    • 4
  • Urvi Sanghvi
    • 2
  • Lilian Hoffecker
    • 5
  • Marylyn McEwen
    • 6
  • Stacie L. Daugherty
    • 7
  • Irene V. Blair
    • 8
  • Elizabeth Calhoun
    • 9
  • Esther de Groot
    • 10
  • Nancy K. Sweitzer
    • 1
  • Pamela N. Peterson
    • 7
    • 11
  1. 1.Division of Cardiovascular Medicine, Sarver Heart CenterUniversity of Arizona College of MedicineTucsonUSA
  2. 2.Department of NursingUniversity of Colorado Anschutz Medical Center CampusAuroraUSA
  3. 3.Division of Geriatric MedicineUniversity of Colorado Anschutz Medical Center CampusAuroraUSA
  4. 4.Division of Hospital MedicineUniversity of Colorado Anschutz Medical Center CampusAuroraUSA
  5. 5.Health Sciences LibraryUniversity of Colorado Anschutz Medical Center CampusAuroraUSA
  6. 6.Department of Nursing, Division of Community and Systems Health ScienceUniversity of ArizonaTucsonUSA
  7. 7.Division of CardiologyUniversity of Colorado Anschutz Medical Center CampusAuroraUSA
  8. 8.Department of Psychology and NeuroscienceUniversity of Colorado BoulderBoulderUSA
  9. 9.Division of Population Health SciencesUniversity of ArizonaTucsonUSA
  10. 10.Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtNetherlands
  11. 11.Division of CardiologyDenver Health Medical CenterDenverUSA

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