Unveiling the role of physician implicit bias and communication behaviors in dissatisfaction, mistrust, and nonadherence in Black patients with Type 2 diabetes

揭示医生隐性偏见和沟通行为在 2 型糖尿病黑人患者的不满、不信任和不依从性中的作用

• 批准号: 9383473
• 负责人: Nao Hagiwara
• 金额: $ 48.56万
• 依托单位: VIRGINIA COMMONWEALTH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-07-01 至 2021-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9383473
• 关键词: Adherence; African American; Attitude; Behavior; Behavioral; Client satisfaction; Clinical; Code; Communication; Diabetes Mellitus; Emotions; Ethnic Origin; Eye; Frequencies; Goals; Intervention; Interview; Literature; Measurement; Medical; Medical Records; Methodology; Methods; Monitor; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Patient-Focused Outcomes; Patients; Persons; Physician' s Role; Physicians; Physiological; Posture; Provider; Public Health; Race; Reaction; Recruitment Activity; Reporting; Research; Research Personnel; Role; Sampling; Social Psychology; Speech; Speed; Surveys; Time; Treatment Protocols; Trust; communication behavior; compliance behavior; design; emotional reaction; experimental study; health care service utilization; implicit bias; improved; innovation; medication compliance; racial bias; racial disparity; satisfaction; skills training; stem; time use; treatment adherence

Patient-physician racial discordance is strongly associated with patient dissatisfaction and mistrust in physicians, which is further associated with poor treatment adherence and suboptimal healthcare utilization. This poses serious public health challenges because approximately 80-90% of Black patients see physicians from different racial groups. Patient dissatisfaction and mistrust have been recently found to be particularly magnified when physicians hold high levels of automatic, implicit bias toward Black Americans, suggesting that physicians’ implicit racial bias impacts physician communication behaviors during medical interactions and ultimately Black patient outcomes. The overall goal of this research is to identify physicians’ communication behaviors during medical interactions that are associated with physicians’ implicit racial bias and Black patients’ immediate (satisfaction, trust) as well as clinically important longer-term outcomes (adherence, healthcare utilization). To achieve this goal, we target medical interactions involving Black patients with Type 2 diabetes mellitus (T2DM) because nonadherence in Black patients with T2DM is particularly prevalent. Additionally, the patient-physician communication quality has been found to predict patient adherence to T2DM treatment regimens. We will use a mixed-methods design that integrates the strengths of inductive reasoning to explore which physicians’ communication behaviors during medical interactions matter from Black patients’ perspectives and deductive reasoning to identify theoretically and clinically important behaviors. Our aims are: Aim 1) to explore which physician communication behaviors during medical interactions are perceived negatively or positively by Black patients and why; Aim 2) to identify which physician communication behaviors identified in Aim 1 are associated with physicians’ implicit racial bias; and Aim 3) to examine how physicians’ implicit racial bias impacts Black patients’ satisfaction, trust, adherence, and healthcare utilization through physicians’ communication behaviors. We will use an innovative integration of multiple methods (interviews, video-recorded medical interactions, surveys, medical record reviews). Findings from this research will enable researchers to identify physician communication behaviors during medical interactions that are problematic and beneficial to the immediate and longer-term outcomes among Black patients with T2DM. Such an ability is needed to develop personally-tailored, targeted communication skills training and other interventions targeting patient-provider interactions to overcome racial disparities in diabetes treatment adherence, outcomes, and beyond. Additionally, upon completion of this project, we will have a Medical Interaction involving Black Patients Coding System (MIBPCS) that differs from prior patient-physician communication coding systems in that it: (1) will focus on physicians’ communication behaviors during medical interactions that can predict Black patients’ outcomes; and (2) places an unprecedented importance on the patients’ point of view.

患者与医生的种族不一致与患者的不满和不信任密切相关 医生，这进一步与治疗依从性差和医疗保健利用率不佳有关。 这带来了严重的公共卫生挑战，因为大约 80-90% 的黑人患者去看医生 最近发现来自不同种族群体的患者尤其不满和不信任。 当医生对美国黑人抱有高度自动的、隐性的偏见时，这种偏见就会被放大，这表明 医生隐性的种族偏见影响医生在医疗互动过程中的沟通行为 这项研究的最终目标是确定黑人患者的治疗结果。 医疗互动过程中的沟通行为与医生的隐性行为相关 种族偏见和黑人患者的直接（满意度、信任）以及临床上重要的长期 为了实现这一目标，我们的目标是涉及医疗互动。 患有 2 型糖尿病 (T2DM) 的黑人患者，因为患有 T2DM 的黑人患者的不依从性 此外，还发现患者与医生的沟通质量可以预测。 患者对 T2DM 治疗方案的依从性 我们将使用整合了以下方法的混合方法设计。 归纳推理的优势在于探索医生在医疗过程中的沟通行为 从黑人患者的角度和演绎推理的角度来看，相互作用很重要，以在理论上和 我们的目标是： 目标 1) 探索哪些医生沟通行为。 在医疗互动过程中，黑人患者感到消极或积极，以及原因 2) 确定； 目标 1 中确定的哪些医生沟通行为与医生隐含的种族相关 偏见；目标 3）研究医生隐含的种族偏见如何影响黑人患者的满意度、信任度、 我们将通过医生的沟通行为来提高依从性和医疗保健利用。 多种方法的整合（访谈、录像医疗互动、调查、病历 这项研究的结果将使研究人员能够识别医生的沟通行为。 在有问题但有益于近期和长期结果的医疗互动过程中 患有 T2DM 的黑人患者需要这种能力来制定针对性的、有针对性的治疗方案。 沟通技巧培训和其他针对患者与提供者互动的干预措施，以克服种族歧视 糖尿病治疗依从性、结果等方面的差异。 项目中，我们将拥有一个涉及黑人患者编码系统（MIBPCS）的医疗互动，该系统不同于 现有的医患沟通编码系统：（1）将重点关注医生的沟通 医疗互动期间的行为可以预测黑人患者的结果；(2) 放置一个 患者的观点前所未有的重要。