Results Summary

What was the project about?

Treatment decisions for depression and diabetes are complex. Talking about and paying attention to patient treatment preferences may improve patients’ health as well as their ability to take treatment as recommended. Previous studies have shown that patients’ preferences for treatments vary by race and ethnicity. For Black and Hispanic or Latino patients, factors such as past discrimination in health care may affect treatment preferences.

Researchers can use experiments to learn what patients prefer. Discrete choice experiments, or DCEs, describe care options with different features, such as type of treatments offered or out-of-pocket costs. Patients fill out surveys about which options they prefer. From their choices, researchers learn what’s most important to patients.

In this study, the research team used a DCE to learn what types of treatment adults of different races and ethnicities preferred for depression and diabetes. Treatments included

  • Medicine only, talk therapy only, or both for depression
  • Medicine only, behavior change only, or both for diabetes

The research team also looked at whether experiences of past discrimination in health care affected patient preferences.

What were the results?

For both depression and diabetes, Black and Hispanic or Latino adults didn’t have treatment preferences. White adults preferred medicine only for both.

Black and Hispanic or Latino adults were more likely to experience discrimination in health care than Whites. Among those who reported past discrimination,

  • Black and Hispanic or Latino adults preferred medicine only for depression.
  • Black and White adults preferred behavior change only for diabetes.

Who was in the study?

The study included 1,512 adults with depression, diabetes, or both. Of these, 33 percent were Black, 33 percent were Hispanic/Latino, and 33 percent were White. All were part of a national survey panel.

What did the research team do?

The research team developed a survey. The survey asked adults to choose between two doctors for mental health or diabetes care. The survey had 18 comparisons. In each, the doctors differed in five features, such as treatment offered or out-of-pocket cost. The survey also asked about experiences with discrimination in health care.

Patient advocates, community health workers, and patient experience professionals helped design and conduct the study.

What were the limits of the project?

The research team looked at only one point in time; they can’t say for sure that discrimination led to patients’ treatment preferences. The study compared doctors on a limited set of features. These features may not capture actual treatment decisions.

Future research could look at how doctors can talk with patients about treatment preferences and past discrimination.

How can people use the results?

Doctors can use these results when considering how past experiences of discrimination may affect patients’ treatment preferences.

Final Research Report

View this project's final research report.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:

  • The reviewers asked for more information about the sampling strategy for the national survey component of the study given the very high response rate, which is unusual for such surveys. The researchers explained that they used a nationally representative survey panel, where members received compensation for the surveys they completed.
  • The reviewers asked for more explanation of the proposed mediation analyses in the study. The researchers explained that conceptually, they hypothesized and sought to investigate whether the effect of perceived discrimination on patient-reported quality of medical care was mediated by the therapeutic relationship between clinician and patient. The researchers acknowledged that they could not fully assess the mediational hypothesis because the timing of data collection for all three constructs did not allow for the researchers to test causation. Instead, the researchers used established methods for testing relationships between such constructs in cross-sectional data.

Conflict of Interest Disclosures

Project Information

Benjamin Cook, PhD, MPH
Cambridge Health Alliance
$1,057,330 *
Helping Doctors Understand Racial/Ethnic Minority Patients' Treatment Preferences to Improve Patients' Healthcare Experiences

Key Dates

April 2016
February 2021

Study Registration Information

Final Research Report

View this project's final research report.

Journal Articles


Has Results
Award Type
Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: January 20, 2023