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Pollak KI, Davenport CA, Duck V, Falls A, Pepka S, Parente V, Jackson LR, Johnson KS. Discriminatory and valuing communication behaviors in cardiology encounters. Patient Education and Counseling 2024; 123:108224. [PMID: 38395022 PMCID: PMC10997491 DOI: 10.1016/j.pec.2024.108224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/05/2024] [Accepted: 02/19/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVE Many have found racial differences in clinician-patient communication using validated codebooks that represent effective communication. No codebooks used for examining racial differences, however, have included patient input. In this paper, we describe creating codebook with Black patient advocates to determine if we could reliably code discriminatory/valuing communication and assess racial differences in these behaviors. METHODS We created a codebook for discriminatory/valuing communication behaviors with the input of Black patient advocates. We used the codebook to analyze data from 101 audio recorded encounters between White cardiologists and Black and White patients. We examined the differences in the prevalence of behaviors in cardiology encounters. RESULTS In comparison to White patients, cardiologists made fewer tailoring statements to their Black patients (68% vs. 49%, p = 0.07). Coders found 4 instances of stereotyping behaviors and only Black patients (p = 0.12). We found no significant associations between any of the other outcomes and patient race. Black patients had a lower incidence of tailoring statements (p = 0.13), lower incidence of interrupting statements (p = 0.16), and higher rushed global score (p = 0.14). CONCLUSION AND PRACTICE IMPLICATIONS We found that coders can reliably identify discriminatory/valuing behaviors in cardiology encounters. Future work should apply these codes to other datasets to assess their validity and generalizability.
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Affiliation(s)
- Kathryn I Pollak
- Cancer Prevention and Control, Duke Cancer Institute, Durham, NC, USA; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
| | | | - Veronica Duck
- Cancer Prevention and Control, Duke Cancer Institute, Durham, NC, USA
| | - Allison Falls
- Department of Psychology, Duke University, Durham, NC, USA
| | - Sara Pepka
- Department of Psychology, Duke University, Durham, NC, USA
| | - Victoria Parente
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Larry R Jackson
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Kimberly S Johnson
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA; Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs Medical Center, Durham, NC, USA
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Hantzmon SV, Davenport CA, Das Gupta MN, Adekunle TA, Gaither SE, Olsen MK, Pinheiro SO, Johnson KS, Mahoney H, Falls A, Lloyd L, Pollak KI. Race differences in patient trust and distrust from audio-recorded cardiology encounters. Patient Educ Couns 2024; 119:108083. [PMID: 37989068 PMCID: PMC10842896 DOI: 10.1016/j.pec.2023.108083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/06/2023] [Accepted: 11/16/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE Many have reported racial disparities in self-reported trust in clinicians but have not directly assessed expressions of trust and distrust in physician-patient encounters. We created a codebook to examine racial differences in patient trust and distrust through audio-recorded cardiologist-patient interactions. METHODS We analyzed data from a randomized controlled trial of audio-recorded outpatient cardiology encounters (50 White and 51 Black patients). We created a codebook for trust and distrust that was applied to recordings between White cardiologists and White and Black patients. We assessed differences in trust, distrust, and guardedness while adjusting for patient age, sex, and first appointment with the cardiologist. RESULTS Compared to White patients, Black patients had significantly lower expressions of trust ([IRR] [95 % CI]: 0.59 [0.41, 0.84]) and a significantly lower mean guarded/open score ([β] [95 % CI] -0.38 [-0.71, -0.04]). There was no statistically significant association between race and odds of at least one distrustful expression (OR [95 % CI] 1.36 [0.37, 4.94]). CONCLUSION AND PRACTICE IMPLICATIONS We found that coders can reliably identify patient expressions of trust and distrust rather than relying on problematic self-reported measures. Results suggest that White clinicians can improve their communication with Black patients to increase expressions of trust.
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Affiliation(s)
- Sarah V Hantzmon
- Cancer Prevention and Control Program, Duke Cancer Institute, Durham, NC, USA
| | | | - Maya N Das Gupta
- Cancer Prevention and Control Program, Duke Cancer Institute, Durham, NC, USA
| | - Temi A Adekunle
- Department of Psychology and Neuroscience, Duke University Trinity College of Arts and Sciences, Durham, NC, USA
| | - Sarah E Gaither
- Department of Psychology and Neuroscience, Duke University Trinity College of Arts and Sciences, Durham, NC, USA; Samuel DuBois Cook Center on Social Equity, Duke University, Durham, NC, USA
| | - Maren K Olsen
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA; Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Sandro O Pinheiro
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Kimberly S Johnson
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA; Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs Medical Center, Durham, NC, USA
| | - Hannah Mahoney
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Allison Falls
- Department of Psychology and Neuroscience, Duke University Trinity College of Arts and Sciences, Durham, NC, USA
| | - Lauren Lloyd
- Department of Psychology and Neuroscience, Duke University Trinity College of Arts and Sciences, Durham, NC, USA
| | - Kathryn I Pollak
- Cancer Prevention and Control Program, Duke Cancer Institute, Durham, NC, USA; Department of Population Health Sciences, Duke University, Durham, NC, USA.
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