Physician Communication Behaviors and Trust Among Black and White Patients With Hypertension
ABSTRACT BACKGROUND:: Racial differences in patient trust have been observed, but it is unclear which physician communication behaviors are related to trust, and whether the relationship of communication and trust differs among black and white patients. OBJECTIVE:: We sought to determine whether there were associations between physician communication behaviors, visit process measures, and patient trust, particularly within racial groups. METHODS:: Study participants included 39 primary care physicians and 227 black and white hypertensive patients from community-based practices in Baltimore, MD. Physician informational and affective communication behaviors and visit process measures were coded from visit audiotapes using the Roter Interaction Analysis System. Patient trust was measured using items from the Trust in Physician Scale, and dichotomized (high/low). Logistic regression analysis using generalized estimating equations was used to assess the association of each physician communication behavior and visit process measure with patient trust, among the entire sample and then stratified by patient race. RESULTS:: Positive physician affect and longer visits were significantly associated with high patient trust in unadjusted analyses. After adjustment for covariates, positive physician affect remained a significant predictor of high patient trust in the overall sample (odds ratio 1.26; 95% confidence interval, 1.08, 1.48; P=0.004) and after stratification by race, among black patients (odds ratio 1.35; 95% confidence interval, 1.09, 1.67; P=0.006). CONCLUSIONS:: Physician communication behaviors may have a varying effect on patient trust, depending on patient race. Communication skills training programs targeting emotion-handling and rapport-building behaviors are promising strategies to reduce disparities in health care and to enhance trust among ethnic minority patients.
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ABSTRACT: With growing evidence that some men with prostate cancer (PCa) may be overtreated, clinicians need greater knowledge of the factors that influence uptake of treatment recommendations in general, and specifically, uptake of active surveillance in patients for whom this is an appropriate treatment option. The objective of this study was to test the role of the quality of the physician-patient relationship in the choice to be followed by active surveillance, rather than receive definitive therapy (e.g., surgery and radiation). We hypothesized that patients would have been more influenced by their physicians' treatment recommendations to the degree that they held more positive perceptions of their relationship with their physicians, independent of treatment recommended.Urologic Oncology 12/2013; 32(4). DOI:10.1016/j.urolonc.2013.09.018 · 3.36 Impact Factor
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ABSTRACT: OBJECTIVE To examine the associations of several characteristics with patients’ trust in physician and the healthcare system. METHODS A prospective cohort of patients were followed after an exacerbation of heart failure at one of two Veterans Affairs (VA) hospitals. Patients rated pre-visit and post-visit trust in physician and in the VA healthcare system at follow-up outpatient visits. The associations of trust in physician and VA with covariates were analyzed using multivariate mixed-effects regression. RESULTS After adjusting for covariates, post-visit trust in physician was significantly higher than pre-visit trust (P<.001), but was not significantly different by race. Trust in VA did not change significantly over time (P>.20), but was significantly lower for Black patients (P<.001). High self-efficacy to communicate was independently associated with both trust in physician and VA (P < 0.001). CONCLUSIONS Trust in physician improved over the course of each visit. Trust in VA was not associated with time, but was lower among black patients. Trust was higher when ratings of communication were higher. PRACTICE IMPLICATIONS Trust in physician improved at each visit and was independently associated with communication. Interventions designed to improve communication should be tested for their ability to improve trust in physician and trust in the healthcare system.Patient Education and Counseling 11/2014; 97(2). DOI:10.1016/j.pec.2014.07.022 · 2.60 Impact Factor
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ABSTRACT: Despite available, effective therapies, racial and ethnic disparities in care and outcomes of hypertension persist. Several interventions have been tested to reduce disparities; however, their translation into practice and policy is hampered by knowledge gaps and limited collaboration among stakeholders. We characterized factors influencing disparities in blood pressure (BP) control by levels of an ecological model. We then conducted a literature search using PubMed, Scopus, and CINAHL databases to identify interventions targeted toward reducing disparities in BP control, categorized them by the levels of the model at which they were primarily targeted, and summarized the evidence regarding their effectiveness. We identified 39 interventions and several state and national policy initiatives targeted toward reducing racial and ethnic disparities in BP control, 5 of which are ongoing. Most had patient populations that were majority African-American. Of completed interventions, 27 demonstrated some improvement in BP control or related process measures, and 7 did not; of the 6 studies examining disparities, 3 reduced, 2 increased, and 1 had no effect on disparities. Several effective interventions exist to improve BP in racial and ethnic minorities; however, evidence that they reduce disparities is limited, and many groups are understudied. To strengthen the evidence and translate it into practice and policy, we recommend rigorous evaluation of pragmatic, sustainable, multilevel interventions; institutional support for training implementation researchers and creating broad partnerships among payers, patients, providers, researchers, policymakers, and community-based organizations; and balance and alignment in the priorities and incentives of each stakeholder group. © American Journal of Hypertension, Ltd 2014. All rights reserved. For Permissions, please email: firstname.lastname@example.org.American Journal of Hypertension 12/2014; 28(6). DOI:10.1093/ajh/hpu233 · 3.40 Impact Factor