DURHAM, N.C. – Black patients at risk for sudden cardiac arrest have historically been less likely to receive potentially life-saving implantable cardioverter defibrillators (ICD) than white patients.
The reasons for this inequity are multifactorial and include a higher rate of refusal to have the implant among Black patients.
To address this reluctance, Duke Health researchers developed a video-based decision aid for Black patients. The intervention was tested in a randomized clinical trial, with results appearing online April 3 in the Annals of Internal Medicine.
Study investigators — including lead author Kevin Thomas, M.D., professor in the Department of Medicine and vice dean for Equity, Diversity and Inclusion at Duke University School of Medicine — found that while increasing patient knowledge, the video did not increase the number of Black patients choosing to pursue ICD implantation.
Thomas and colleagues found that approximately 60% of study participants chose to undergo ICD implantation and the video tool performed no better or worse than the usual patient education provided by the physician and care team in the clinical setting.
The study also aimed to assess whether the racial identities of the video participants would increase the likelihood that Black patients at risk for cardiac arrest would opt for an implantable cardioverter defibrillator (ICD).
One video decision aid featured a Black physician and testimonials from Black patients; a second video had a white clinician and white patient testimonials. The video tool featuring Black physicians and patients led to outcomes that were the same as a video featuring white physicians and patients.
The findings highlight a need for additional understanding of the factors Black patients consider in medical decision-making along racial lines and other contributors to racial inequities in ICD implantation.
Thomas said biomedical research often focuses on describing health inequities, rather than probing the reasons for the inequity and devising interventions to address the inequity and testing them in a methodologically rigorous way.
“There are so many things that could contribute to a person’s decision about a procedure to implant a medical device, and many of those are cultural,” Thomas said. “One question to ask is how a patient feels about their quality of life rather than longevity.
“Furthermore, I’ve had patients say, ‘I don’t want something inside my body, I just don’t,’” Thomas said. “And so, the question becomes, do those personal values that influence preferences differ by race and culture.”
Beyond the findings, Thomas said the existence of the study itself is significant. It included 343 Black participants, and of those who were approached for the study, 80% said yes to enrolling.
“This is evidence to support that one of the biggest reasons that we don’t have more diversity in clinical trials is that we don’t ask people of color to participate,” Thomas said. “If you ask, they’re going to be more likely to participate.”
While he said he was surprised by the result, he said the study is a model for a more relevant approach and points to a need for continued research that seeks to understand the complex interplay of how social determinants of health and cultural influences drive medical decision-making and health outcomes.
In addition to Thomas, study authors include Sana M. Al-Khatib; Andrzej S. Kosinski; Samuel F. Sears, Jr.; Nancy M. Allen LaPointe; Larry R. Jackson II; Daniel D. Matlock; Daniel Haithcock; B. Judson Colley III; David S. Hirsh; and Eric D. Peterson.
The study was funded by the Patient-Centered Outcomes Research Institute (AD-1503-29746).