Research Project 2

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Abstract - Project 2 TITLE: The effect of a clinician communication coaching intervention on racial disparities in the quality of communication in cardiology encounters High quality care depends squarely on communication between clinicians and patients. Robust evidence links effective communication to important patient outcomes, such as higher adherence, higher satisfaction, and lower malpractice suits. One study even linked physician empathy with lower hbA1c levels. Quality of communication differs, however, for African American compared to white patients. Many have reported race differences both in the perception of communication and in observed ratings of communication. These race differences can impact not just the patient experience of care but also the actual care patients receive. Cardiology is an area where race differences in communication can lead to life altering outcomes. When cardiologists provide different care based on patient race, disparities in comorbidity and mortality persist. Although many have documented race differences, few have attempted to reduce the gap in patient-physician communication between African Americans and whites. One strategy for reducing the gap of care involves improving overall communication, particularly focusing on expressing empathy and attempting to improve patient engagement. This is especially important in race-discordant (white physician, African-American patient) given evidence that physicians often struggle communicating with patients of other races. Research indicates that African Americans engage in less participatory behaviors and physicians elicit less participatory behaviors among their African American patients compared to Whites. Teaching physicians how to promote more question asking and support for autonomy for all patients could reduce this gap. In this application, our multidisciplinary team applies a well- established approach to achieving clinician-patient alignment in the cardiology setting. We propose to conduct a two-arm randomized controlled trial with cardiologists in which half of the cardiologists receive a coaching intervention that focuses on teaching empathic skills and eliciting participatory behaviors. Our primary outcome is improved physician communication as assessed by analysis of audio recordings of patient-physician encounters. Our secondary outcome is patients' perceptions of the quality of patient centered communication. Our premise is that incorporation of these techniques will improve providers' ability to effectively communicate with all patients and will reduce racial disparities in actual and perceived quality of provider communication quality with African-American and White patients.