Nonverbal communication of patient and physician racial attitudes and its effect on cancer treatment disparities

 描述（由申请人提供）：癌症治疗中的种族差异不成比例地影响黑人癌症患者。2003年医学研究所的报告《不平等的治疗》以及来自传播科学、社会心理学和临床医学的研究表明，可能导致这些治疗差异的两个因素：1）在种族不和谐的情况下，医患沟通的质量（即，黑人患者，非黑人医生）讨论治疗的诊所访问，和2）患者和医生访视前的种族态度。关于沟通，先前的研究，包括我们自己的，表明种族不和谐的诊所访问是不太积极和生产力比种族一致的诊所访问，和绝大多数（75%）的访问与黑人患者种族不和谐。研究还表明，患者和医生的种族态度，特别是患者群体对医疗保健的不信任和医生对黑人的隐性偏见，影响了诊所访问期间的沟通质量。种族态度主要是通过微妙的非语言/类语言的交际行为，然而，很少有研究已经确定了种族态度的行为表现在诊所访问。需要更好地理解种族态度对患者和医生非语言/准语言沟通的影响，因为与语言行为相比，它们在互动中传达更多的意义和情感。我们建议通过对临床交流和黑白癌症治疗差异的更大研究的数据进行二次分析来解决这一差距。使用的数据包括：黑人患者（n=120）和非黑人肿瘤学家（n=19）之间的视频记录的癌症诊所访问、诊所访问的记录、患者和肿瘤学家自我报告的访问前种族态度和访问后对诊所访问和彼此的看法以及关于接受的治疗的医学记录数据。我们的第一个目标是确定的表现形式的病人和医生的负面种族态度，通过应用研究开发的，基于理论的非语言/paraverbal通信编码系统的视频记录的诊所访问的数据集的“薄片”。我们的第二个目标是使用目标1的发现来确定a）医生和患者的种族态度是否以及如何影响非语言/副语言沟通行为，以及B）这些行为在多大程度上影响患者和医生对彼此的看法以及治疗的适当性（与NCCN指南一致）。我们的研究意义重大，因为研究结果将加深我们对种族态度、临床沟通和治疗差异之间关系的理解， 采取知情干预措施，以改善沟通，减少保健差距。这项研究是创新的，因为它侧重于非语言/paraverbal通信在种族不和谐的诊所访问，它采用了二元理论，认为人际交往从组间水平，它利用“薄片”的方法在一个新的方式，它采用多层次的统计分析，这将导致一个独特的理解的互惠性质的诊所访问。

 DESCRIPTION (provided by applicant): Racial disparities in cancer treatment disproportionately affect Black patients with cancer. The 2003 Institute of Medicine report, Unequal Treatment, and research from communication science, social psychology, and clinical medicine suggest two factors that likely contribute to these treatment disparities: 1) the quality f patient-physician communication during racially discordant (i.e., Black patient, non-Black physician) clinic visits in which treatment is discussed, and 2) patient and physician pre-visit racial attitudes. With regard to communication, prior research, including our own, demonstrates that racially discordant clinic visits are less positive and productive than racially concordant clinic visits, and a great majority (75%) of visits with Black patients are racially discordant. Research also suggests that patient and physician racial attitudes, specifically patient group-based mistrust in medical care and physician implicit bias against Black people, affect the quality of communication during clinic visits. Racial attitudes are largely expressed through subtle nonverbal/paraverbal communicative behaviors; however, little research has identified the behavioral manifestation of racial attitudes during clinic visits. A greater understanding of te influence of racial attitudes on patient and physician nonverbal/paraverbal communication is needed because they convey more meaning and emotion in interactions, compared to verbal behavior. We propose to address this gap through a secondary analysis of data from a larger study of clinical communication and Black-White cancer treatment disparities. Data to be used include: video recorded cancer clinic visits between Black patients (n=120) and non-Black oncologists (n=19), transcripts of the clinic visits, patient and oncologist self-reported pre-visi racial attitudes and post-visit perceptions of the clinic visit and of each other, and medical recod data on treatment received. Our first aim is to identify the manifestations of patient and physician negative racial attitudes by applying an investigator developed, theory-based nonverbal/paraverbal communication coding system to "thin slices" of the data set of video recorded clinic visits. Our second aim is to use findings from Aim 1 to determine a) whether and how physician and patient racial attitudes influence nonverbal/paraverbal communication behaviors, and b) the extent to which those behaviors influence patient and physician perceptions of each other and the appropriateness of treatment (consistent with NCCN guidelines). Our study is significant because findings will deepen our understanding of relationships among racial attitudes, clinical communication, and treatment disparities, and inform interventions to improve communication and reduce healthcare disparities. This research is innovative because it focuses on nonverbal/paraverbal communication in racially discordant clinic visits, it employs a dyadic theory that considers interpersonal communication from an intergroup level, it utilizes "thin slice" methodology in a novel way, and it employs multi-level statistical analyses that will result in a unique understanding of the reciprocal nature of the cliic visit.