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)
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.
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.
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.
Perceptions that physicians were less informative, less supportive and less likely to share decision-making explained black patients lower trust in physicians.
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.