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Naming the downsides of surgery: racial and gender variations in cultural notions of surgery’s hazards 9_30
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Naming the downsides of surgery: racial and gender variations in cultural notions of surgery’s hazards 9_30


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  • 1. Methods
    • Freelists ranged 1 to 13 items (median 4, IQR 4,6).
    • 2. Pain and time required for recovery were the two most salient downsides noted among both blacks and whites; the need for anesthesia and perceptions of being “too old” were more salient among blacks individuals, the risk of death was salient among whites but not blacks.
    • 3. Both genders viewed pain as the most salient downside to surgery; the inability to care for one’s self after surgery was a highly salient downside among women; scarring was salient for men, but not women.
    • 4. No single “culturally correct” notion of surgery’s downsides by race or gender
    • 5. Participants of differing races and gender voiced many of the same concerns regarding surgery, yet notable subgroup differences in salient terms also occurred.
    • 6. Among all participants and within subgroups, more than one factor emerged as part of the definition of surgery’s downsides.
    • 7. Differences in responses between males and females may reflect variations in social supports.
    • 8. Sample: English-speaking, community-dwelling white and black adults, aged 70 and older from an urban geriatric medicine practice.
    • 9. Data Collection: Freelists of “all the downsides of surgery you can name;” demographics and medical history questionnaire.
    • 10. Data analysis: Cultural consensus analyses for the full sample and race and gender subgroups; items ranked by Smith’s S, a measure of salience incorporating item frequency and order of appearance; Content analysis of freelist items by race/gender.
    • 11. Variations in medical decisions regarding elective surgery may contribute to racial and gender disparities in care.
    • 12. Racial and gender differences in perceptions of the downsides of surgery according may underlie group differences in decision-making.
    • “Insider” perspectives on surgery’s downsides are relevant to improving doctor-patient communication, prioritizing areas for quality improvement and designing interventions to improve care delivery.
    • 13. Further investigation is needed to elucidate cultural differences in how the downsides of surgery are perceived and defined.
    • To describe common perceptions of the downsides of surgical care among community-dwelling older adults.
    • 14. To ascertain variation in such perceptions according to race and gender
    Naming the downsides of surgery: racial and gender variations in cultural notions of surgery’s hazards
    Mark D. Neuman, M.D.1,2, Chidimma Osigwe, B.A.1, Said Ibrahim, M.D., M.P.H. 2,3,4, Fran Barg, Ph.D.5,6,
    Jason H. Karlawish, M.D.2,3
    (1) Department of Anesthesiology and Critical Care, University of Pennsylvania (2) The Leonard Davis Institute for Health Economics, University of Pennsylvania, (3) Department of Medicine, University of Pennsylvania; (4) VA Medical Center, Philadelphia, Pennsylvania, (5) Department of Family and Community Medicine, University of Pennsylvania; (6) Department of Anthropology, University of Pennsylvania
    • Romney, A.K., et. al. AmerAnthro . 1986, 88 (2): 313-338.
    • 15. Schrauf, R.W. & Sanchez, J. J. Gerontology: Social Sciences 2008; 63 (6): S385-S393