African American, patients' perspectives on medical decision making

Background: The medical literature offers little information about how older African Americans view the medical decision-making process. We sought to describe the perspectives of older African American patients in a primary care clinic as they consider a medical decision. Methods: We interviewed 25 African American patients older than 50 years who had discussed flexible sigmoidoscopy with their primary care provider. Interviews were analyzed using qualitative methods. Results: Patients listed concerns about cancer and health, risks and benefits, their own understanding of the test, and the recommendation of the provider as the most important factors in their decision. Most patients wanted information about medical tests and procedures to increase their understanding and to provide reassurance rather than to guide decision making. Most patients explained that they wanted the provider to make medical decisions because of his or her training and experience. Despite this, many expressed a sense of ownership or control over one's own body. Patients thought trust was built by a health care provider's honesty, patience, kindness, interest, and continuity of care. Conclusions: Although traditional models of informed consent have emphasized providing patients with information to guide autonomous decision making, patients may want this information for other reasons. Fully informing patients about their medical condition increases understanding and provides reassurance. Because many of these patients want their provider to participate in making medical decisions, he or she should not only provide information but should also provide guidance to the patient.