Does Race Influence Decision Making for Advanced Heart Failure Therapies?
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Open Access
- 19 November 2019
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of the American Heart Association
- Vol. 8 (22), e013592
- https://doi.org/10.1161/jaha.119.013592
Abstract
Background Race influences medical decision making, but its impact on advanced heart failure therapy allocation is unknown. We sought to determine whether patient race influences allocation of advanced heart failure therapies. Methods and Results Members of a national heart failure organization were randomized to clinical vignettes that varied by patient race (black or white man) and were blinded to study objectives. Participants (N=422) completed Likert scale surveys rating factors for advanced therapy allocation and think‐aloud interviews (n=44). Survey results were analyzed by least absolute shrinkage and selection operator and multivariable regression to identify factors influencing advanced therapy allocation, including interactions with vignette race and participant demographics. Interviews were analyzed using grounded theory. Surveys revealed no differences in overall racial ratings for advanced therapies. Least absolute shrinkage and selection operator regression selected no interactions between vignette race and clinical factors as important in allocation. However, interactions between participants aged ≥40 years and black vignette negatively influenced heart transplant allocation modestly (−0.58; 95% CI, −1.15 to −0.0002), with adherence and social history the most influential factors. Interviews revealed sequential decision making: forming overall impression, identifying urgency, evaluating prior care appropriateness, anticipating challenges, and evaluating trust while making recommendations. Race influenced each step: avoiding discussing race, believing photographs may contribute to racial bias, believing the black man was sicker compared with the white man, developing greater concern for trust and adherence with the black man, and ultimately offering the white man transplantation and the black man ventricular assist device implantation. Conclusions Black race modestly influenced decision making for heart transplant, particularly during conversations. Because advanced therapy selection meetings are conversations rather than surveys, allocation may be vulnerable to racial bias. See Editorial Shirey and MorrisKeywords
This publication has 34 references indexed in Scilit:
- The 2013 International Society for Heart and Lung Transplantation Guidelines for mechanical circulatory support: Executive summaryThe Journal of Heart and Lung Transplantation, 2013
- Integrating usability testing and think-aloud protocol analysis with “near-live” clinical simulations in evaluating clinical decision supportInternational Journal of Medical Informatics, 2012
- The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT): A New Tool for the Psychosocial Evaluation of Pre-Transplant CandidatesPsychosomatics, 2012
- In the 21st Century, what is an acceptable response rate?Australian and New Zealand Journal of Public Health, 2012
- THE IMPACT OF RACISM ON CLINICIAN COGNITION, BEHAVIOR, AND CLINICAL DECISION MAKINGDu Bois Review: Social Science Research on Race, 2011
- Cardiac Performance Measure Compliance in Outpatients: The American College of Cardiology and National Cardiovascular Data Registry's PINNACLE (Practice Innovation And Clinical Excellence) ProgramJournal of the American College of Cardiology, 2010
- Qualitative and Mixed Methods Provide Unique Contributions to Outcomes ResearchCirculation, 2009
- Implicit Bias among Physicians and its Prediction of Thrombolysis Decisions for Black and White PatientsJournal of General Internal Medicine, 2007
- Outcomes With an Alternate List Strategy for Heart TransplantationThe Journal of Heart and Lung Transplantation, 2005
- Network Sampling: Some First StepsAmerican Journal of Sociology, 1976