HISPANIC PATIENTS' DESIRE TO PARTICIPATE IN PRIMARY CARE TREATMENT DECISION MAKING

Purpose: The aim of this study was to examine the factors that correlate with Hispanic patients’ decision role preferences for participation in treatment decision making with their primary care provider (PCP). 

Method: Hispanic patients (n=772) were recruited from five zip codes in Northern Manhattan and survey data were collected via interview by bilingual community health workers in two outpatient clinics. Data were analyzed using multinomial logistic regression to investigate the association between sociodemographic and health factors and role preference (passive [reference], shared, active) ¹in primary care treatment decision making.

Result: Most survey respondents preferred to participate in medical treatment decisions in a shared or active role (89%) and also had inadequate health literacy (95%). The odds of wanting to participate in decision making in a shared role with a PCP were significant (p <=0.05) for participants who were younger age (OR=0.98, 95% CI [0.96- 0.99), less than 21 years living in the United States (OR=0.48, 95% CI [0.27- 0.88]), adequate health literacy (Newest Vital Sign) (OR=.46, 95% CI [0.25- 0.83]), better ability to understand health instructions, pamphlets or written health materials (OR=0.55, 95% CI [0.31- 0.99]), and higher social role performance (OR=0.97, 95% CI [0.94- 0.99]). The odds of wanting to participate in decision making in an active role with a PCP were significant (p <=0.05) for respondents with higher education (OR=3.11, 95% CI [1.20- 8.04]), less than 21 years living in the United States (OR=0.37, 95% CI [0.19- 0.73]), and younger age (OR=0.98, 95% CI [0.95- 0.99]). However, the overall models demonstrated poor fit with study data explaining 10% -14% of the variation of the dependent variable.

Conclusion: Although the majority of patients (95%) in our sample had low health literacy, most of the respondents (89%) wanted to participate in treatment decision making. Consequently, there are a number of informatics and clinical implications. To satisfy Hispanic patient’s desire to participate in SDM clinicians will need to provide decision aids that are health literacy appropriate.  Informatics interventions can support clinicians by customizing decision aids content using a number of patient specific factors, including health literacy level.