Compassion Disparities in Primary Care: A Mixed Methods Pilot Study

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Project Summary/Abstract Background: Healthcare disparities are meaningful differences in healthcare quality linked to patient race, ethnicity, socioeconomic status (SES), or other factors. There is a vital element of healthcare quality with a paucity of data on disparities: compassion from treating clinicians. Compassion is highly valued by patients and essential for high quality healthcare. For example, a lack of clinician compassion could contribute to patient distrust of the healthcare system, which is associated with patient non-adherence to health maintenance and treatment recommendations. Understanding compassion disparities is vital for improving healthcare equity. Health disparity populations may receive less compassion from clinicians due to implicit bias and/or racism. However, our prior research has shown that conventional after-care patient experience (satisfaction) surveys are prone to nonresponse bias and thus are inadequate to test for compassion disparities. Anonymous, real- time, point-of-care assessments are needed. This is a critically important knowledge gap for healthcare equity. Compared to nondisparity populations, we hypothesize that (1) patients in health disparity populations experience less compassion from clinicians, (2) less compassion for health disparity populations mediates healthcare system distrust, and (3) salient clinician behaviors that communicate compassion (or lack of) from the patient perspective differ for health disparity populations. Objectives: In a diverse population of primary care patients, (1) we will test for differences in patient experience of clinician compassion between White patients without low SES and (a) Black or African American, (b) Hispanic or Latinx, or (c) low SES patients. (2) We will test if patient experience of clinician compassion mediates differences in healthcare system distrust between the populations above. (3) From the patient perspective, we will identify differences in salient clinician behaviors that communicate compassion (or lack of) between the populations above. Methods/environment: In a network of 26 diverse academic primary care clinics, we will perform a cross-sectional mixed methods cohort study collecting anonymous, real-time, point-of-care assessments of clinician compassion from the patient perspective (n=350). We will use the 5-Item Compassion Measure, a semi-quantitative research tool that we validated in three prior studies including real-time evaluation. We will test for differences in the populations above adjusted for patient, system, and clinician-level factors. We will also use the validated Healthcare System Distrust Scale to test if clinician compassion mediates (i.e., is on the causal pathway for) patient distrust of the healthcare system for the populations above. We will use open-ended questions (i.e., qualitative methods) to identify salient differences in clinician behaviors that communicate (or detract from) compassion from the patient perspective for the populations above. These data will inform a future R01 application to develop and test patient-informed training curricula for clinicians to raise compassion for health disparity populations and reduce patient distrust of the healthcare system through elimination of compassion disparities.