Nonverbal synchrony as a behavioural marker of patient and physician race-related attitudes and a predictor of outcomes in oncology interactions: protocol for a secondary analysis of video-recorded cancer treatment discussions

Abstract

IntroductionRacial disparities in cancer treatment contribute to racial disparities in mortality rates. The quality of patient–physician communication during clinical interactions with black patients and non-black physicians (racially discordant) is poorer than communication quality with white patients (racially concordant). Patient and physician race-related attitudes affect the quality of this communication. These attitudes are likely expressed through subtle non-verbal behaviours, but prior research has not examined these behaviours. Nonverbal synchrony, the coordination of physical movement, reflects the preinteraction attitudes of participants in interactions and predicts their postinteraction perceptions of and affect towards one another. In this study, peer reviewed and funded by the National Institute of Minority Health and Health Disparities (R21MD011766), we will investigate non-verbal synchrony in racially concordant and discordant interactions to better understand racial disparities in clinical communication.Methods and analysisThis secondary analysis includes racially concordant (n=163) and racially discordant (n=68) video-recorded oncology interactions, patient and oncologist self-reported race-related attitudes, perceptions of the interaction and observer ratings of physician patient-centred communication and patient and physician affect and rapport. In aim 1, we will assess and compare non-verbal synchrony between physicians and patients in racially concordant and discordant interactions. In aim 2, we will determine the influence of non-verbal synchrony on patient and physician affect and communication. In aim 3, we will examine possible causes (ie, race-related attitudes) and consequences (ie, negative perceptions) of non-verbal synchrony in racially discordant interactions. In aim 4, we will develop and test a mediational model linking physician and patient race-related attitudes to non-verbal synchrony and, in turn, interaction outcomes.Ethics and disseminationThe parent and current studies were approved by the Wayne State University Institutional Review Board. Since only archival data will be used, ethical or safety risks are low. We will disseminate our findings to relevant conferences and journals.

Beyond Convenience: Patients’ Perceptions of Physician Interactional Skills and Compassion via Telemedicine

“…Nonverbal synchrony of facial expression and movement, although usually unintentional, builds rapport and trust and contributes to collaboration in solving problems. 22 Analysis and measurement of nonverbal communication in video-based interactions would be an area of interest for future research because it contributes to patient satisfaction and understanding of health issues, which, in turn, mediate adherence and other health outcomes. 23,24 To this end, automated video analysis methods are now under development.…”

Examining the dynamic nature of nonverbal communication between Black patients with cancer and their oncologists

“…Questions remain regarding whether poor quality clinical communication is associated with patient race or the racial concordance/discordance of the patient–physician dyad 46 . However, most Black patients' clinical interactions are with physicians who are not Black (ie, racially discordant), due to a shortage of Black/African American physicians, and especially oncologists, 24 making this distinction difficult to study using naturally occurring clinical interactions.…”

“…Similarly, the dataset included mostly female patients with breast cancer who interacted with both male and female physicians, which prevented us from performing a meaningful comparison of the influence of patient sex on the findings. Future research should examine similar interactions with patients and providers from other backgrounds, 47 sexes, genders, and medical contexts. These limitations notwithstanding, this study marks a considerable step forward in understanding of the dynamic nature of nonverbal communication between Black patients and their oncologists.…”

Validity and Reliability of the Japanese Version of the 10-Item Perceived Efficacy in Patient-Physician Interactions (PEPPI-10) Scale in Breast Cancer Outpatients

“…PEPPI-10 is a questionnaire used to measure patient's perceived self-efficacy in interacting with physicians, and the impact of empowerment interventions (Maly et al 1998). Recently, study protocols for investigating physician communication behaviors (Hagiwara et al 2018) and behavioral markers of patient and physician race-related attitudes (Hamel et al 2018) have been published. The doctor-patient relationship is a key component in patient health outcomes (Whittal and Lippke 2016); yet, little is known about perceived self-efficacy in doctor-patient interactions (Raymond et al 2011).…”