Purpose: Numerous studies have found that Black patients are more risk averse than their White counterparts. In clinical practice, patients make judgments based on oral information provided to them by their physicians; yet most studies have examined patients' perceptions using written information. The objective of this study was to examine the factors underlying Black and White patients' treatment preference after hearing about a new medication described to them orally by a physician.
Methods: Subjects with a connective tissue disease were recruited from University-affiliated rheumatology practices. Subjects listened to a professionally-recorded standardized description of a medication. Prior to hearing the description, demographic characteristics (by self-report), trust in physicians, patient activation, and subjective numeracy (using validated scales) were ascertained. Helpfulness of the proposed treatment, fear about the side effects, and willingness to take the medication were measured using 7-point numeric rating scales. Kendall Tau b correlation coefficients are reported.
Results: We interviewed 284 subjects (71 Black and 213 White). Increased helpfulness and less fear of side effects were associated with increased willingness to take the medication among Black (r= 0.60, p<0.0001 and r= -0.22, p=0.02, respectively) and White subjects (r= 0.49, p<.0001 and r= -0.36, p<.0001, respectively). Helpfulness and fear were inversely correlated in White (r= -0.126, p<.0001), but not Black subjects (r= 0.007, p=0.9). Older age was associated with decreased willingness to take the medication among White subjects only. Trust and subjective numeracy did not have a direct effect on willingness to take the medication in either Black or White subjects. However, higher subjective numeracy was associated with increased perceived helpfulness in White subjects (r= 0.125, p=0.005) and greater trust was associated with increased perceived helpfulness (r= 0.20, p=0.02) in Black subjects. Neither numeracy nor trust was associated with fear of side effects.
Conclusions: After hearing about a medication, Black patients' treatment preferences were indirectly influenced by trust and directly influenced by perceived helpfulness of the proposed treatment and fear of the side effects. In contrast, White subjects treatment preferences were indirectly influenced by numeracy and directly influenced by age, perceived helpfulness and fear of the side effects. An inverse relationship between perceived helpfulness and fear (indicative of a confounding effect) was observed among White, but not Black subjects.
