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对黑人癌症患者的影响不成比例。2003年医学研究所的报告《不平等待遇》以及来自传播学、社会心理学和临床医学的研究提出了可能导致这些治疗差异的两个因素：1)在讨论治疗的种族不和谐(即黑人患者和非黑人医生)诊所就诊期间，患者与医生之间的沟通质量；2)患者和医生就诊前的种族态度。关于沟通，之前的研究，包括我们自己的研究表明，种族不和谐的诊所就诊不如种族和谐的诊所就诊积极和富有成效，而且绝大多数(75%)的黑人患者就诊是种族不和谐的。研究还表明，患者和医生的种族态度，特别是基于患者群体对医疗保健的不信任，以及医生对黑人的隐性偏见，影响了就诊期间的沟通质量。种族态度在很大程度上是通过微妙的非语言/副语言交流行为来表达的；然而，很少有研究确定在诊所就诊期间种族态度的行为表现。需要更多地了解种族态度对患者和医生非语言/副语言交流的影响，因为与语言行为相比，它们在互动中传达了更多的意义和情感。我们建议通过对来自临床沟通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。将使用的数据包括：黑人患者(n=120)和非黑人肿瘤学家(n=19)之间的癌症诊所访问的视频记录、临床访问的文字记录、患者和肿瘤学家自我报告的访问前的种族态度和访问后对诊所访问和彼此的看法，以及关于所接受治疗的医疗记录数据。我们的第一个目标是通过将研究人员开发的、基于理论的非语言/副语言交流编码系统应用于视频门诊数据集的“薄片”，来识别患者和医生消极种族态度的表现。我们的第二个目标是利用目标1中的发现来确定a)医生和患者的种族态度是否以及如何影响非言语/副沟通行为，以及b)这些行为影响患者和医生对彼此的看法和治疗的适当性的程度(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，以及 告知干预措施，以改善沟通和减少医疗保健差距。这项研究具有创新性，因为它集中在种族不和谐的诊所就诊中的非言语/副椎体沟通，它采用了从群体间水平考虑人际沟通的二元论，它以一种新颖的方式利用了“薄片”方法，它使用了多层次的统计分析，这将导致对团结性就诊的互惠性质的独特理解。

 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.