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Med Care. 2011 Jul;49(7):626-33. doi: 10.1097/MLR.0b013e318215d93c.

Impact of perceived discrimination in healthcare on patient-provider communication.

Author information

  • 1VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, Pittsburgh, PA, USA. leslie.hausmann@gmail.com

Abstract

BACKGROUND:

The impact of patients' perceptions of discrimination in healthcare on patient-provider interactions is unknown.

OBJECTIVE:

To examine association of past perceived discrimination with subsequent patient-provider communication.

RESEARCH DESIGN:

Observational cross-sectional study.

SUBJECTS:

African-American (N=100) and white (N=253) patients treated for osteoarthritis by orthopedic surgeons (N=63) in 2 Veterans Affairs facilities.

MEASURES:

Patients were surveyed about past experiences with racism and classism in healthcare settings before a clinic visit. Visits were audio-recorded and coded for instrumental and affective communication content (biomedical exchange, psychosocial exchange, rapport-building, and patient engagement/activation) and nonverbal affective tone. After the encounter, patients rated visit informativeness, provider warmth/respectfulness, and ease of communicating with the provider. Regression models stratified by patient race assessed the associations of racism and classism with communication outcomes.

RESULTS:

Perceived racism and classism were reported by more African-American patients than by white patients (racism: 70% vs. 26% and classism: 73% vs. 53%). High levels of perceived racism among African-American patients was associated with less positive nonverbal affect among patients [β=-0.41, 95% confidence interval (CI)=-0.73 to -0.09] and providers (β=-0.34, 95% CI=-0.66 to -0.01) and with low patient ratings of provider warmth/respectfulness [odds ratio (OR)=0.19, 95% CI=0.05-0.72] and ease of communication (OR=0.22, 95% CI=0.07-0.67). Any perceived racism among white patients was associated with less psychosocial communication (β=-4.18, 95% CI=-7.68 to -0.68), and with low patient ratings of visit informativeness (OR=0.40, 95% CI=0.23-0.71) and ease of communication (OR=0.43, 95% CI=0.20-0.89). Perceived classism yielded similar results.

CONCLUSIONS:

Perceptions of past racism and classism in healthcare settings may negatively impact the affective tone of subsequent patient-provider communication.

PMID:
21478769
[PubMed - indexed for MEDLINE]
PMCID:
PMC3117903
Free PMC Article

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