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

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Abstract

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.

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Funding

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.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona College of Medicine, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA

    Khadijah Breathett & Nancy K. Sweitzer

  2. Department of Nursing, University of Colorado Anschutz Medical Center Campus, Aurora, CO, USA

    Jacqueline Jones, Dawn Koonkongsatian & Urvi Sanghvi

  3. Division of Geriatric Medicine, University of Colorado Anschutz Medical Center Campus, Aurora, CO, USA

    Hillary D. Lum

  4. Division of Hospital Medicine, University of Colorado Anschutz Medical Center Campus, Aurora, CO, USA

    Christine D. Jones

  5. Health Sciences Library, University of Colorado Anschutz Medical Center Campus, Aurora, CO, USA

    Lilian Hoffecker

  6. Department of Nursing, Division of Community and Systems Health Science, University of Arizona, Tucson, AZ, USA

    Marylyn McEwen

  7. Division of Cardiology, University of Colorado Anschutz Medical Center Campus, Aurora, CO, USA

    Stacie L. Daugherty & Pamela N. Peterson

  8. Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA

    Irene V. Blair

  9. Division of Population Health Sciences, University of Arizona, Tucson, AZ, USA

    Elizabeth Calhoun

  10. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands

    Esther de Groot

  11. Division of Cardiology, Denver Health Medical Center, Denver, CO, USA

    Pamela N. Peterson

Authors
  1. Khadijah Breathett
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  2. Jacqueline Jones
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  3. Hillary D. Lum
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  4. Dawn Koonkongsatian
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  5. Christine D. Jones
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  6. Urvi Sanghvi
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  9. Stacie L. Daugherty
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  10. Irene V. Blair
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  11. Elizabeth Calhoun
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  12. Esther de Groot
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  13. Nancy K. Sweitzer
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  14. Pamela N. Peterson
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Correspondence to Khadijah Breathett.

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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.

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

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Breathett, K., Jones, J., Lum, H.D. et al. Factors Related to Physician Clinical Decision-Making for African-American and Hispanic Patients: a Qualitative Meta-Synthesis. J. Racial and Ethnic Health Disparities 5, 1215–1229 (2018). https://doi.org/10.1007/s40615-018-0468-z

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