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: 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: 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. Patients with PCa (n = 120) being followed with active surveillance at a comprehensive cancer center completed self-report assessments of their treatment decision-making process. Generalized estimating equations were used to model the association between participants' perceptions of their relationships with their physicians and influence of these physicians' recommendations on their treatment decision. After controlling for the type of treatment recommended, Gleason score, and education, 3 predictors, trust in the physician, perceived closeness with the physician, and the degree to which the physician shared control over treatment decision making, were associated with greater influence of physician's treatment recommendation. Receiving a recommendation for active surveillance, compared with definitive therapy, was also associated with higher perceived trust, closeness, shared control over treatment decision making, lower likelihood of having been treated poorly by a physician, and greater influence of physician's treatment recommendation. There is increasing concern that patients with relatively less aggressive PCa, older age, or serious comorbidities are being unnecessarily treated with surgery or radiation, putting them at risk for side effects, and contributing to high health care costs. When active surveillance is an appropriate course of treatment, the quality of patients' relationships with their physicians may be a determinant of following a recommendation for active surveillance. Results may have implications for treatment uptake in general, indicating that the quality of the physician-patient relationship, including trust, closeness, shared decision making-all elements of patient-centered care-may be important motivators of treatment adoption and adherence.Urologic Oncology 12/2013; DOI:10.1016/j.urolonc.2013.09.018 · 3.36 Impact Factor
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ABSTRACT: Our objectives were to: 1) describe patient-reported communication with their provider and explore differences in perceptions of racially diverse adherent versus nonadherent patients; and 2) examine whether the association between unanswered questions and patient-reported medication nonadherence varied as a function of patients' race. We conducted a cross-sectional analysis of baseline in-person survey data from a trial designed to improve postmyocardial infarction management of cardiovascular disease risk factors. Overall, 298 patients (74%) reported never leaving their doctor's office with unanswered questions. Among those who were adherent and nonadherent with their medications, 183 (79%) and 115 (67%) patients, respectively, never left their doctor's office with unanswered questions. In multivariable logistic regression, although the simple effects of the interaction term were different for patients of nonminority race (odds ratio [OR]: 2.16; 95% confidence interval [CI]: 1.19-3.92) and those of minority race (OR: 1.19; 95% CI: 0.54-2.66), the overall interaction effect was not statistically significant (P=0.24). The quality of patient-provider communication is critical for cardiovascular disease medication adherence. In this study, however, having unanswered questions did not impact medication adherence differently as a function of patients' race. Nevertheless, there were racial differences in medication adherence that may need to be addressed to ensure optimal adherence and health outcomes. Effort should be made to provide training opportunities for both patients and their providers to ensure strong communication skills and to address potential differences in medication adherence in patients of diverse backgrounds.Patient Preference and Adherence 02/2015; 9:311-8. DOI:10.2147/PPA.S75393 · 1.49 Impact Factor