Racial differences in doctors' information-giving and patients' participation

Authors

  • Howard S. Gordon MD,

    Corresponding author
    1. Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois
    2. VA Midwest Center for the Health Services and Policy Research, Hines, Illinois
    3. Sections of General Internal Medicine and Health Promotion Research, Department of Medicine, University of Illinois, Chicago, Illinois
    • Michael E. DeBakey Veterans Affairs Medical Center (152), 2002 Holcombe Blvd., Houston, TX 77030
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    • At the time this work was conducted, Drs. Gordon and Souchek were employed at the Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.

    • Fax: (713) 748-7359

  • Richard L. Street Jr. PhD,

    1. Houston Center for Quality of Care and Utilization Studies, Section of Health Service Research, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas
    2. Department of Communication, Texas A&M University, College Station, Texas
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  • Barbara F. Sharf PhD,

    1. Department of Communication, Texas A&M University, College Station, Texas
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  • Julianne Souchek PhD

    1. Houston Center for Quality of Care and Utilization Studies, Section of Health Service Research, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas
    2. Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
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    • At the time this work was conducted, Drs. Gordon and Souchek were employed at the Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.


  • Presented in part at the annual meeting of the Society of General Internal Medicine, New Orleans, Louisiana, May 12, 2005; and at the annual meeting of the VA Health Services Research and Development Service, Crystal City, Virginia, February 17, 2006.

  • The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

Abstract

BACKGROUND

Whether doctor-patient communication differs by race was investigated in patients with pulmonary nodules or lung cancer.

METHODS

Eligible patients (n = 137) had pulmonary nodules or lung cancer and were seen in thoracic surgery or oncology clinics for initial treatment recommendations at a large southern Veterans Affairs Medical Center from 2001–2004. Doctor-patient consultations were audiotaped. Audiotapes were transcribed, unitized into utterances, and utterances were coded as doctors' information-giving or patients' and companions' active participation (asking questions, expressing concerns, and making assertions). Data were compared by patient race and doctor-patient racial concordance using t-tests or chi-square tests as appropriate. Mixed linear regression was used to determine the independent predictors of doctor's information-giving after controlling for clustering of patients by doctor.

RESULTS

Patient age, gender, marital status, clinical site, and health status were similar by race (P > .20), but black patients were somewhat less likely to have education beyond high school and to bring a companion to the visit (P = .06) than white patients. Black patients and their companions received significantly less information from doctors (49.3 vs. 87.3 mean utterances; P < .001) and produced significantly fewer active participation utterances (21.4 vs. 37.2; P < .001) than white patients. In mixed regression analyses, after adjusting for patients' and companions' participation, clustering by doctor, and other factors, race no longer predicted information-giving (P = .54). Patients in racially discordant interactions received significantly less information and were significantly less active participants (P < .001) when compared with patients in racially concordant interactions, and after controlling for patients' participation and other factors using mixed regression, racial discordance did not predict information-giving.

CONCLUSIONS

The results indicate a pattern of communication that may perpetuate patient passivity and limited information exchange where black patients and patients in discordant interactions do less to prompt doctors for information and doctors in turn provide less information to these patients. Cancer 2006. © 2006 American Cancer Society.

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