Clinician Cultural Competence and Racial Disparity in Doctor-patient Relationships

Saha S, Gatchell M, O’Neil MO, Bates J, Gordon H, Long J, Washington D. Clinician Cultural Competence and Racial Disparity in Doctor-patient Relationships. Paper presented at: American Academy on Communication in Healthcare Research and Teaching Forum; 2014 Oct 18; Orlando, FL.

Related HSR&D Project(s)

• ECV 04-296 – Measuring Cross-Cultural Competence in VA Primary Care

Background: Clinician cultural competence (CC) has been promoted to improve the quality of doctor-patient relationships for minority patients and reduce racial disparities in healthcare quality. Few studies, however, have empirically examined which CC dimensions, if any, are associated with better relationships and greater equity. Methods: We previously developed a multidimensional instrument measuring clinician CC, using 6 scales: Perceived Cultural Aptitude, Perceived Cross-Cultural Efficacy, Awareness of Racial Disparities, Valuing Diverse Perspectives, Support for Accommodating Patient Diversity, and Patient-Centered Orientation. Primary care providers (PCPs) at 4 geographically diverse clinics completed this instrument. We surveyed patients from participating PCPs' panels, and administered 4 validated measures assessing patients' perceptions of the PCP (Table 1). We tested which CC dimensions were associated with higher minority patient ratings and then tested interactions between provider CC and patient race, to determine whether CC dimensions were associated with reduced disparity in patient ratings. Results: We recruited 96 PCPs (49% white, 27% Asian) and 998 of their patients (62% African American, 31% white). The CC dimension most consistently associated with higher minority patient ratings was Valuing Diverse Perspectives (VDP). PCPs scoring above the median on VDP received higher ratings from African American patients on communication quality and interpersonal style (Table 1). Higher VDP was not associated with white patients' ratings. We found significant provider VDP-patient race interactions for all 4 patient ratings; racial disparities were present among PCPs with lower VDP scores but not among those with higher VDP scores (Table 2). Conclusions: Providers scoring higher on Valuing Diverse Perspectives - a construct similar to cultural humility - received higher ratings from African American patients and had less racial disparity in the quality of their relationships with patients. VDP may be an important target, and intermediate outcome measure, for CC interventions aimed at reducing racial disparities in healthcare quality.