Medical decision-making among Hispanics and non-Hispanic Whites with chronic back and knee pain: A qualitative study

Abstract

BackgroundMusculoskeletal disorders affect all racial and ethnic groups, including Hispanics. Because these disorders are not life-threatening, decision-making is generally preference-based. Little is known about whether Hispanics in the U.S. differ from non-Hispanic Whites with respect to key decision making preferences.MethodsWe assembled six focus groups of Hispanic and non-Hispanic White patients with chronic back or knee pain at an urban medical center to discuss management of their conditions and the roles they preferred in medical decision-making. Hispanic groups were further stratified by socioeconomic status, using neighborhood characteristics as proxy measures. Discussions were led by a moderator, taped, transcribed and analyzed using a grounded theory approach.ResultsThe analysis revealed ethnic differences in several areas pertinent to medical decision-making. Specifically, Hispanic participants were more likely to permit their physician to take the predominant role in making health decisions. Also, Hispanics of lower socioeconomic status generally preferred to use non-internet sources of health information to make medical decisions and to rely on advice obtained by word of mouth. Hispanics emphasized the role of faith and religion in coping with musculoskeletal disability. The analysis also revealed broad areas of concordance across ethnic strata including the primary role that pain and achieving pain relief play in patients' experiences and decisions.ConclusionsThese findings suggest differences between Hispanics and non-Hispanic Whites in preferred information sources and decision-making roles. These findings are hypothesis-generating. If confirmed in further research, they may inform the development of interventions to enhance preference-based decision-making among Hispanics.

Decisional Control Preferences of Hispanic Patients With Advanced Cancer From the United States and Latin America

“…This study confirms the importance of family participation in DCPs for both HUSs and HLAs. 15,29 Although both HUSs and HLAs wanted family participation, HUSs were much less likely to want family members to make decisions on their behalf.…”

The Pain Experience of Hispanic Americans: A Critical Literature Review and Conceptual Model

“…Therefore, it is unsurprising that numerous investigations have found that HAs often endorse using religious coping methods, such as prayer, to manage pain. Compared to NHWs, HAs report using more religious coping for experimental pain 65 and clinical pain; 30,42,50,77,130 HAs and NHBs report similar use of religious coping. 30,42,50,65,130 Compared to NHWs with acute pain, a greater proportion of HAs report talking about their pain with a minister, pastor, or someone else at their place of worship and report praying to God that the pain would go away.…”

“…77,99,101,109,118,123 This reluctance appears to be driven, in part, by cultural beliefs. For example, MAs with chronic pain reported that they believed that pain should be overcome without medication and that medication is only acceptable when it is “absolutely necessary,” such as when pain interferes with one’s ability to perform social roles or work.…”

“…99 Negative attitudes toward pain medications are also related to fears of adverse treatment outcomes. 77 While such negative attitudes about strong pain medications are not unique to HAs, one investigation found that, compared to NHWs, HAs reported more fear of negative treatment outcomes and this fear inhibited them from seeking pain care. 77 Furthermore, HAs with chronic pain reported significantly more fears of combining pain medications and greater concerns about becoming addicted to pain medications compared to NHWs.…”

“…77 While such negative attitudes about strong pain medications are not unique to HAs, one investigation found that, compared to NHWs, HAs reported more fear of negative treatment outcomes and this fear inhibited them from seeking pain care. 77 Furthermore, HAs with chronic pain reported significantly more fears of combining pain medications and greater concerns about becoming addicted to pain medications compared to NHWs. 101,109 Concerns about addiction and building a tolerance to pain medications, particularly opioids, were discussed by HAs in several qualitative studies.…”