Nonverbal Synchrony as a Behavioral Maker of Patient and Physician Racial Attitudes and Predictor of Outcomes of Clinical Interactions

项目摘要 癌症治疗中的种族差异可能会导致种族死亡率差异。医学研究所 报告、不平等待遇和其他研究表明，医患沟通的质量 在种族不和谐(黑人患者，非黑人医生)的临床互动中，约占80% 在黑人患者的临床互动中，可能会导致治疗差异。之前的研究，包括我们的 发现这些互动不如种族和谐的互动那么积极和富有成效；以及 患者和医生的种族态度(例如，患者对黑人接受的医疗护理的怀疑；医生含蓄 种族偏见)影响互动期间的沟通质量。这种种族态度在很大程度上是表达出来的 通过微妙的非语言行为；然而，以前的研究并没有集中在这些行为上或对其进行检查 它们的动态、互惠的表达方式。这个项目将通过检查非语言同步性来实现这一点，或者 身体运动的协调性；研究表明，这反映了互动前的态度和预测 参与者在互动后对彼此的认知，以及对彼此的影响。因此，我们将调查 在种族和谐和种族不和谐互动中的非语言同步作为一种更好的手段 了解临床交流中的种族差异。数据将包括：种族一致性(n=163)和 种族不一致(n=68)视频记录的肿瘤学互动，患者和肿瘤学家自我报告种族 态度，访问后对互动和彼此的感知，以及对医生的观察者评级 以患者为中心的沟通，患者和医生的情感和融洽。目标1是评估和 比较种族和谐和种族不和谐的医生和患者之间的非语言同步性 使用创新软件和分析方法的肿瘤学互动，捕捉微妙和互惠的 这一沟通渠道的性质。目标2是确定非语言同步性的相对影响 论种族和谐与种族不和谐中的医患情感与沟通 肿瘤学的相互作用。目标3是检查种族中非语言同步的原因和后果 不协调的肿瘤学相互作用。目标4是开发和测试一个将医生和患者种族联系起来的模型 对非语言同步的态度，进而对互动结果的态度。这项研究具有重要意义，因为研究结果 将提高对1)种族和谐和种族和谐的非语言交流差异的认识 不协调的肿瘤学交互作用，2)在肿瘤学交互作用中种族态度是如何沟通的，3) 这种沟通如何影响互动结果，以及4)微妙的非语言沟通如何起到作用 与待遇差异有关。这一知识提供了关于种族不和谐交流的信息。 可用于医学教育和治疗差异干预评估的互动。这个 这项研究具有创新性，因为它考察了一种影响互动的未被探索的沟通渠道 结果，使用创新方法评估动态、互惠的医患沟通。

Project Abstract Racial disparities in cancer treatment may contribute to racial mortality disparities. The Institute of Medicine report, Unequal Treatment, and other research suggests that the quality of patient-physician communication during racially discordant (Black patient, non-Black physician) clinical interactions, which constitute about 80% of Black patients' clinical interactions, likely contributes to treatment disparities. Prior research, including our own, finds that these interactions are less positive and productive than racially concordant interactions; and patient and physician racial attitudes (e.g., patient suspicion of medical care Blacks receive; physician implicit racial bias) affect the quality of communication during interactions. Such racial attitudes are largely expressed through subtle nonverbal behaviors; however, prior research has not focused on these behaviors or examined the dynamic, reciprocal way they are expressed. This project will do this by examining nonverbal synchrony, or the coordination of physical movement; which research shows reflects pre-interaction attitudes and predicts participants' post-interaction perceptions of each other and affect toward one another. Thus, we will investigate nonverbal synchrony in both racially concordant and racially discordant interactions as a means to better understand racial disparities in clinical communication. Data will include: racially concordant (n = 163) and racially discordant (n = 68) video-recorded oncology interactions, patient and oncologist self-reported racial attitudes, post-visit perceptions of the interaction and of each other, as well as observer ratings of physician's patient-centered communication, and patient and physician affect and rapport. Aim 1 is to assess and compare nonverbal synchrony between physicians and patients in racially concordant and racially discordant oncology interactions using innovative software and analytical methods that capture the subtle and reciprocal nature of this channel of communication. Aim 2 is to determine the relative influence of nonverbal synchrony on patient and physician affect and communication displayed in racially concordant and racially discordant oncology interactions. Aim 3 is to examine causes and consequences of nonverbal synchrony in racially discordant oncology interactions. Aim 4 is to develop and test a model that links physician and patient racial attitudes to nonverbal synchrony and, in turn, interaction outcomes. This study is significant because findings will improve knowledge of 1) differences in nonverbal communication in racially concordant and racially discordant oncology interactions, 2) how racial attitudes are communicated during oncology interactions, 3) how this communication affects interaction outcomes, and 4) how subtle nonverbal communication contributes to treatment disparities. This knowledge provides information about communication in racially discordant interactions that can be used in medical education and evaluations of treatment disparity interventions. The study is innovative because it examines an unexplored channel of communication affecting interaction outcomes, using innovative methods to assess dynamic, reciprocal patient-physician communication.