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Author List:
Gordon HS (Houston VA)
Street RL (Dept of Communication, Texas A&M University)
Kelly PA (Houston VA)
Sharf BF (Dept of Communication, Texas A&M University)
Souchek J (Houston VA)
Objectives:
Racial disparities in treatment of lung cancer are well documented but poorly explained. We investigated whether racial differences in patient trust are associated with physician-patient communication.
Methods:
Eligible patients had pulmonary nodules or lung cancer and were seen in thoracic surgery or oncology clinics for initial treatment recommendations at a large southern VA. Questionnaires were used to determine patients' self-identified race, health status, perceptions of doctors' communication (informativeness, support, and decision-making style), and trust in physician and system (VA). Trust in physician (5-items) and trust in VA (4-items) were assessed before and after the visit. Responses were on a 10-point scale. Survey data were compared by patient race using t-tests or chi-square tests as appropriate. We used multiple linear regression to determine the independent predictors of post-visit trust in physician and VA and to control for pre-visit trust.
Results:
Complete data were obtained for 100 patients (23% black, 77% white). Age, gender, marital status, site, and health status did not differ by race, but black patients had less education (P=0.01) than white patients. Pre-visit trust in physician and VA, and post-visit trust in VA did not differ by race. Black patients had lower post-visit trust in physician (mean score 8.0 vs. 9.3; P=0.02) than white patients. Compared with whites, blacks judged doctors as less informative (7.3 vs. 8.5; P=0.04), less supportive (8.1 vs 9.2; P=0.04) and less likely to share decision-making (6.4 vs. 8.2; P=0.001). In multiple regression analyses, pre-visit trust and black race were significant (P<0.001) predictors of post-visit trust in doctor, even after controlling for patients' characteristics. However, after controlling for doctors' informativeness, support and decision-making style, pre-visit trust and race were not statistically significant (P>0.15) predictors of post-visit trust in physician. Pre-visit trust in system (VA) significantly (P<0.001) predicted post-visit trust in VA even after controlling for characteristics and communication.
Implications:
Perceptions that physicians were less informative, less supportive and less likely to share decision-making explained black patients lower trust in physicians.
Impacts:
Communication in medical interactions is an important skill that can be taught. Future studies should use more rigorous designs to evaluate the association of communication and outcomes.
