2006 HSR&D National Meeting Abstract
1062 — Racial Differences in Doctors’ Information Giving and Patients’ Participation
Gordon HS (Houston Center for Quality of Care and Utilization Studies)
Street RL (Houston Center for Quality of Care and Utilization Studies)
Racial disparities in treatment of lung cancer are well documented but poorly explained.
We investigated whether doctor-patient communication differs by race. Eligible patients had pulmonary nodules or lung cancer and were seen in thoracic surgery or oncology clinics for initial treatment recommendations at a large southern VA from 2001-2004. Patients self-identified as black (n=30) or white (n=107). Consultations were audiotaped, transcribed, and unitized into utterances. Utterances were coded into categories including doctors’ information-giving (e.g. diagnoses, definitions, rationales, instructions, options, risks, benefits) and patients’ active participation (e.g., questions, assertions, concerns). Information giving was further coded as self-initiated by the doctor or prompted by the patient. Data were compared by patient race using t-tests or chi-square tests. We used mixed linear regression to determine the independent predictors of doctors' information giving, controlling for patient clustering by doctor.
Patient demographics, clinical site, and health status were similar by race (P>0.05). Compared with white patients, consultations with black patients, on average, had fewer doctors’ information giving utterances (49.3 vs. 87.3; P<0.001) and fewer acts of patient participation (21.4 vs. 37.2; P<0.001). Also, both prompted and self-initiated doctors’ information-giving were less frequent in consultations with black compared with white patients (14.5 vs. 34.6; P=0.001 and 34.8 vs. 52.6; P=0.02). In mixed regression analyses, blacks received 24.3 fewer (P=0.01) information giving utterances than whites, controlling for clustering by doctor and other potential covariates. When patients’ active participation was added to the model, doctors’ information-giving did not differ significantly (P=0.54) by patient race, but each act of patient participation was associated with a significant (P=0.001) increase in information from the doctor.
Black patients received less information from doctors in association with less active participation, in this sample of initial consultations for lung cancer. The results suggest that differences in information giving by race are related to the mutuality of communication in medical consultations.
Racial variation in doctor-patient communication becomes an issue of concern especially when considering a growing body of research that links patterns of communication to outcomes of care. Fortunately, communication is a skill that can be taught.