The impact of Black cancer patients' race-related beliefs and attitudes on racially-discordant oncology interactions: A field study

Abstract

Objective Both physician and patient race-related beliefs and attitudes are contributors to racial healthcare disparities, but only the former have received substantial research attention. Using data from a study conducted in the Midwestern US from 2012 to 2014, we investigated whether 114 Black cancer patients’ existing race-related beliefs and attitudes would predict how they and 18 non-Black physicians (medical oncologists) would respond in subsequent clinical interactions. Method At least two days before interacting with an oncologist for initial discussions of treatment options, patients completed measures of perceived past discrimination, general mistrust of physicians, and suspicion of healthcare systems; interactions were video-recorded. Measures from each interaction included patients’ verbal behavior (e.g., level of verbal activity), patients’ evaluations of physicians (e.g., trustworthiness), patients’ perceptions of recommended treatments (e.g., confidence in treatment), physicians’ evaluations of patient personal attributes (e.g., intelligence) and physicians’ expectations for patient treatment success (e.g., adherence). Results As predicted, patients’ race-related beliefs and attitudes differed in their associations with patient and physician responses to the interactions. Higher levels of perceived past discrimination predicted more patient verbal activity. Higher levels of mistrust also predicted less patient positive affect and more negative evaluations of physicians. Higher levels of suspicion predicted more negative evaluations of physicians and recommended treatments. Stronger patient race-related attitudes were directly or indirectly associated with lower physician perceptions of patient attributes and treatment expectations. Conclusion Results provide new evidence for the role of Black patients’ race-related beliefs and attitudes in racial healthcare disparities and suggest the need to measure multiple beliefs and attitudes to identify these effects.

The influence of affective behavior on impression formation in interactions between black cancer patients and their oncologists

“…These low means may be unique to our sample: physicians in our sample have elected to work in a city with a majority Black population; patients with high levels of mistrust and perceived discrimination may not have consented to participate in the study. However, it is worth noting that race-related attitudes did predict post-visit impressions in the current analyses, and that past work with the same patient and physician populations has found consistent relationships between race-related attitudes and post-visit impressions as well as other behaviors during interactions (Penner et al, 2016a,b, 2017). If the lack of relationship between race-related attitudes and affective behavior is replicated in future work, it may be that these attitudes influence impressions through other kinds of nonverbal behavior.…”

“…Patients and physicians enter clinic visits already holding attitudes and beliefs that can impact their impressions and decisions. For example, Black patients’ mistrust of the healthcare system is related to confidence in treatment recommendations (Penner et al, 2017), engagement in genetic counseling (Sheppard et al, 2013), and quality of life (Kinlock et al, 2017). Physicians’ biases and stereotypes can guide their impressions and treatment recommendations (Penner et al, 2014; van Ryn et al, 2006).…”

Sociodemographic predictors of surgery refusal in patients with stage I‐III colon cancer

“…There exists a body of literature regarding the experience of Black patients in the health care system, where a history of medical distrust and ineffective patient‐provider communication can have significantly negative impacts on patients' care 25,26 . Such impacts have been found to be particularly magnified in race‐discordant clinical interactions, and prior work has shown that pre‐existing race‐related beliefs can have significant negative effects on a patients' perception of recommended treatment difficulty and treatment efficacy 27 . Our findings may reflect such race‐related effects.…”

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

“…Our prior research suggests such perceptions and behaviours are associated with less positive patient expectations about recommended treatments 51. We have also found that black patients with higher levels of suspicion of medical care are less optimistic about outcomes of recommended treatments and are perceived by their physicians to be less educated 52. This, in turn, is associated with less positive physician expectations about how their black patients will do on a treatment protocol, such as their adherence and/or ability to tolerate treatment.…”