397 the Relationship Between Patient Race and Patients' Perceptions of Their Physicians' Cultural Competence and Patient-Centered Communication Skills

Abstract

BackgroundPatient-centered communication has been shown to improve compliance and health care outcomes. Recently, it has been suggested that the cultural competence of physicians can impact their ability to effectively communicate with a patient. Our study examines the relationship between patient race, patients' perceptions of the physician's patient-centered communication skills and cultural competence.MethodsThe CCTOP study (Cultural Competency Training and Outcomes in Patients) is a multicenter, cross-sectional study of patients' and physicians' attitudes regarding culture, bias, and clinical care. A 76-item questionnaire was administered to 167 patients. We performed a bivariate analysis of patients' perception of their autonomy in making medical decisions and their doctors' understanding of their culture. We then constructed regression models with patients' perceptions of physicians' communication skills as the outcome with race as the independent variable of interest while controlling for education, income, age, gender, and perceptions of physicians' cultural awareness as possible confounders.ResultsWe report preliminary data based on 167 patients surveyed: 72.5% female, 27.5% male. In terms of race, the patients were 28.7% white, 44.3% African-American, and 22.3% Hispanic. Seventy-seven percent of patients who felt their doctors are aware of their cultural beliefs believed that their doctors gave them some control regarding treatment decisions as opposed to only 58.7% of those who felt their doctor is unaware of their cultural beliefs (OR 5.44, p = .02). Logistic regression analysis adjusting for age, gender, income, and education showed that patients who felt that their doctor understands their culture remained 2.5 times (p = .046) more likely to feel that their doctor gave them some control over treatment decisions. Furthermore, white patients were approximately 4 times more likely to feel that their doctor gave them this autonomy compared to African-American (OR 0.25, p = .017) and Hispanic patients (OR 0.22, p = .022).ConclusionsThese preliminary findings suggest that minority patients are less likely to feel that they have some control in making decisions regarding treatment options. In addition, patients who feel that their doctors understand their culture perceive a greater sense of autonomy in making treatment decisions.

Towards a concept of Communicative Competence in Health: a qualitative study in medical residents

“…54 Regarding autonomy and decision-making, the data obtained is similar to what has been reported herein; that the physician's cultural competency (ability to understand and adapt to the cultural, social and geographical context of the patient) is associated to a greater adherence and higher perception of the patient's autonomy in the decision making process. 55,56,57 It is worth noting the lack of comments about communication with work teams, in contrast with other studies that highlighted the importance of good communication in specific health teams. For example, in the ER, the participation of other professionals and resources is frequently needed.…”