- The outcome I am currently investigating is preference-concordant involvement in decision-making for prenatal genetic testing. Essentially answering the question did patients receive what they want in terms of their preferred level of involvement- desires autonomy, shared decision making or a provider based decision. In the Institute of Medicine's Crossing the Quality Chasm providers are encouraged to engage patients in healthcare decision making to the extent that they desire.
Structural variables I chose were self reported race/ethnicity (and further divided the participants that self-identified as Latina into those that opted for a spanish interview vs english due to potential differences of acculturation between these two groups). I also chose education as a categorical variable and measures of literacy/numeracy (although I'm not sure if this would be considered a structural variable like education). I chose race/ethnicity as a variable to capture potential differences between groups and my analysis reveals that Latina-Spanish speaking women had statistically significantly lower odds of receiving preference-concordant involvement. As the Bravemen article points out, however, this may be due to the unmeasured effect of other SES variables or there could be systematic discrimination.
Education, literacy and numeracy were also included as SES covariates. Differences in education may influence the clinical encounter especially as it relates to a decision for genetic tests that may be difficult to understand the implications or interpretation of results.
An intermediary factor that may factor in is the health system. Although I had information on site that participants were recruited from, I did not have information on for example the use of medical interpreters etc which may have had an effect given the disparity I found for Latina-Spanish speaking women compared to White women.
2. The socioeconomic factors of women's parents- educational attainment for example may be of relevance although I have not read this in published literature as it relates to healthcare decision making especially for prenatal genetic testing.