Session number: 1057
Abstract title: Racial Differences in Physician Perceptions of and Communication with Cardiac Patients
Author(s):
NR Kressin - Bedford COE, Boston Univ. School of Public Health
BH Chang - Bedford COE, Boston Univ. School of Public Health
MB Orner - Bedford COE, Boston Univ. School of Public Health
JA Clark - Bedford COE, Boston Univ. School of Public Health
AK Rosen - Bedford COE, Boston Univ. School of Public Health
XS Ren - Bedford COE, Boston Univ. School of Public Health
ED Peterson - Duke University Medical School
M East - Durham VAMC, Duke University Medical School
L Kroupa - St. Louis VAMC
L Alley, J Whittle, LA Petersen - Atlanta VAMC, Kansas City VAMC & Kansas U. Med Ctr, Houston COE & Baylor College of Medicine
Objectives: African Americans are less likely than whites to receive invasive cardiac procedures. Many have postulated that these care differences may stem from physician bias or communication issues between physicians and patients. We investigated racial differences in these factors.
Methods: We recruited a cohort of cardiac patients who were potential candidates for invasive procedures, selecting white and African American (AA; 23%) patients at 5 VAMCs whose nuclear imaging tests indicated cardiac ischemia. Using survey data collected from physicians and patients (n=792) after these tests, we examined how physicians viewed each of their patients’ clinical status and personal characteristics, and we compared patient and physician perceptions of the conversation about treatment recommendations.
Results: Physicians reported that their white patients had worse functional status (p<.05), that it was more important for their white patients to receive cardiac catheterization (CC; p<.01), that the pre-test probability of coronary artery disease was higher in their white patients (74% vs. 64%; p<.001), and that they more often recommended CC for their white patients (49% vs. 41%; p=.06). They reported that white patients better understood the recommended course of treatment (p<.05), communicate better (p<.05), have higher socioeconomic status (p<.01), are more likely to show up for follow up care (p=.06), and to comply with prescribed medication (p<.01). There were no racial differences in doctors’ views of their patients’ independence, intelligence, patient under-reports of pain, or likelihood to participate in cardiac rehabilitation. We also found evidence of communication discordance within each racial group. Among patients who thought that CC was lifesaving/crucial, their doctors thought its necessity was either equivocal or the risks>benefits 20% of the time in AAs and 11% of the time in whites (p<.01 for each). Further, the patient and doctor disagreed about whether CC had been recommended 14% of the time with AA patients, and 16% of the time with white patients (p<.001 for each).
Conclusions: We observed numerous racial differences in physicians’ perceptions of patients, and discordance within racial groups of patient and physician reports of communication. Communication improvements might decrease racial disparities in care.
Impact statement: We identified several areas where doctor-patient communication might be enhanced, in order to improve provided health care.