Unveiling the role of physician implicit bias and communication behaviors in dissatisfaction, mistrust, and nonadherence in Black patients with Type 2 diabetes

患者与医生之间的种族不和谐与患者的不满和不信任 医生，这进一步与治疗依从性差和医疗保健利用率不佳有关。 这构成了严重的公共卫生挑战，因为大约80%-90%的黑人患者会去看医生 来自不同种族的人。病人的不满和不信任最近被发现尤其是 当医生对美国黑人持有高度自发的、隐含的偏见时，这一点被放大了，这表明 医生的内隐种族偏见影响医疗互动中的医生沟通行为 最终，黑人患者的结果。这项研究的总体目标是确定医生的 与医生内隐相关的医疗互动中的沟通行为 种族偏见与黑人患者的即刻(满意度、信任度)以及长期临床重要性 结果(依从性、医疗保健利用率)。为了实现这一目标，我们的目标是医疗互动，包括 黑人2型糖尿病(T2 DM)患者，因为黑人T2 DM患者不坚持 特别流行。此外，已发现患者与医生之间的沟通质量可以预测 患者坚持T2 DM治疗方案。我们将使用混合方法设计，它集成了 用归纳推理的优势来探索哪些医生在医疗过程中的沟通行为 互动关系从黑人患者的角度和演绎推理，以确定理论和 临床上重要的行为。我们的目标是：目标1)探索哪些医生的沟通行为 在医疗互动过程中，黑人患者认为是负面的还是正面的，以及原因；目的2)确定 目标1中确定的哪些医生沟通行为与医生的内隐种族有关 目的3)研究医生的隐性种族偏见如何影响黑人患者的满意度、信任度、 依从性，通过医生的沟通行为对医疗服务的利用。我们将使用一种创新的 整合多种方法(访谈、视频医疗互动、调查、医疗记录 评论)。这项研究的发现将使研究人员能够识别医生的沟通行为 在有问题并对近期和长期结果有利的医疗互动期间 在患有T2 DM的黑人患者中。需要这样的能力来培养个人定制的、有针对性的 沟通技能培训和其他针对患者与提供者互动的干预措施，以克服种族问题 糖尿病治疗依从性、结果和其他方面的差异。此外，在完成此操作后 项目，我们将有一个涉及黑人患者的医疗互动编码系统(MIBPCS)，不同于 现有的患者-医生通信编码系统包括：(1)将重点放在医生的通信上 在医疗互动中的行为可以预测黑人患者的结果；以及(2)将 从患者的角度来看，这是前所未有的重要。

Patient-physician racial discordance is strongly associated with patient dissatisfaction and mistrust in physicians, which is further associated with poor treatment adherence and suboptimal healthcare utilization. This poses serious public health challenges because approximately 80-90% of Black patients see physicians from different racial groups. Patient dissatisfaction and mistrust have been recently found to be particularly magnified when physicians hold high levels of automatic, implicit bias toward Black Americans, suggesting that physicians’ implicit racial bias impacts physician communication behaviors during medical interactions and ultimately Black patient outcomes. The overall goal of this research is to identify physicians’ communication behaviors during medical interactions that are associated with physicians’ implicit racial bias and Black patients’ immediate (satisfaction, trust) as well as clinically important longer-term outcomes (adherence, healthcare utilization). To achieve this goal, we target medical interactions involving Black patients with Type 2 diabetes mellitus (T2DM) because nonadherence in Black patients with T2DM is particularly prevalent. Additionally, the patient-physician communication quality has been found to predict patient adherence to T2DM treatment regimens. We will use a mixed-methods design that integrates the strengths of inductive reasoning to explore which physicians’ communication behaviors during medical interactions matter from Black patients’ perspectives and deductive reasoning to identify theoretically and clinically important behaviors. Our aims are: Aim 1) to explore which physician communication behaviors during medical interactions are perceived negatively or positively by Black patients and why; Aim 2) to identify which physician communication behaviors identified in Aim 1 are associated with physicians’ implicit racial bias; and Aim 3) to examine how physicians’ implicit racial bias impacts Black patients’ satisfaction, trust, adherence, and healthcare utilization through physicians’ communication behaviors. We will use an innovative integration of multiple methods (interviews, video-recorded medical interactions, surveys, medical record reviews). Findings from this research will enable researchers to identify physician communication behaviors during medical interactions that are problematic and beneficial to the immediate and longer-term outcomes among Black patients with T2DM. Such an ability is needed to develop personally-tailored, targeted communication skills training and other interventions targeting patient-provider interactions to overcome racial disparities in diabetes treatment adherence, outcomes, and beyond. Additionally, upon completion of this project, we will have a Medical Interaction involving Black Patients Coding System (MIBPCS) that differs from prior patient-physician communication coding systems in that it: (1) will focus on physicians’ communication behaviors during medical interactions that can predict Black patients’ outcomes; and (2) places an unprecedented importance on the patients’ point of view.