3013 — Race and Doctor-Patient Communication about Treatment Preference

Borrero SB (HSR&D's Center for Health Equity Research and Promotion (CHERP)), Nikolajski C (CHERP), Zickmund S (CHERP), Kresevic D (Cleveland VA), Mor M (CHERP), Geng M (CHERP), Ibrahim SA (CHERP)

Objectives:
Respect for a patient’s preference is a critical component of patient-centered health care. Few studies have examined the discussion of treatment preference in the medical encounter and whether it varies by patient race. In a sample of patients undergoing evaluation for osteoarthritis (OA), we examined the relationship between patient race and communication about treatment preference.

Methods:
Our sample included patients who were referred to Pittsburgh and Cleveland VA orthopedic clinics for the management of knee/hip OA. The doctor-patient visits were audio-recorded, and a random sample of 100 recordings [50 African-American (AA) and 50 white] were selected for an in-depth mixed-method analysis of discussions regarding patient treatment preferences. A codebook was created to investigate the following domains: patient expression of a treatment preference, whether expressions of preference were patient-initiated, doctor’s level of engagement, and doctor’s vocal tone. We examined the relationship of these communication variables with patient race using Fisher’s Exact tests. Logistic regression analysis was used to model the association between communication and patient race controlling for age, income, health literacy, and education level, study site, and clustering by provider.

Results:
Demographic characteristics were similar for white and AA patients. In bivariate analyses, there were no differences between the two groups in any of the communication variables assessed. Most patients actively expressed a treatment preference to the doctor (92% AA and 96% white, p = 0.68). Among those who expressed a treatment preference, 58% of AA and 66% of white patients (p = 0.52) self-initiated an expression of preference. The doctor was equally likely to be engaged in the preference discussion with AA and white patients (98% vs 90% of encounters, p = 0.20). The doctor’s tone did not differ for AA and white patients (p = 1.00). Because of lack of variability in the communication measures, we were able to perform a multivariable logistic regression analysis on only one measure -- whether expression of preference was patient-initiated. After adjusting for potential confounders, there was no significant difference in patient-initiated expression of preference for AA patients compared to whites (OR: 0.8; 95% CI: 0.2-2.4).

Implications:
In this sample of VA patients, there were no racial variations in doctor-patient communication about treatment preferences. Nearly all patients and doctors were actively engaged in the discussion of treatment preference, and AA and white patients were equally likely to initiate this discussion.

Impacts:
Investigating racial variation in doctor-patient communication is crucial given the accumulating evidence that links patterns of communication to health outcomes.