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，病人与医生沟通的质量 在种族不一致（黑人患者，非黑人医生）的临床相互作用，其中约占80% 黑人患者的临床相互作用，可能有助于治疗差异。先前的研究，包括我们的 发现这些互动不如种族和谐的互动积极和富有成效; 患者和医生的种族态度（例如，病人怀疑黑人接受的医疗护理;医生暗示 种族偏见）影响互动过程中的沟通质量。这种种族态度主要表现在 通过微妙的非语言行为;然而，以前的研究没有集中在这些行为或检查 动态的、相互的表达方式。这个项目将通过检查非语言同步来实现， 身体运动的协调;研究表明，这反映了互动前的态度，并预测 参与者互动后对彼此的看法和对彼此的影响。因此，我们将调查 在种族和谐和种族不和谐的互动中， 了解临床沟通中的种族差异。数据将包括：种族一致（n = 163）和 种族不一致（n = 68）视频记录的肿瘤学相互作用，患者和肿瘤学家自我报告的种族 态度，访问后的相互作用和对方的看法，以及观察员的医生的评级， 以病人为中心的沟通，病人和医生的影响和融洽。目标1是评估和 比较种族一致和种族不一致的医生和患者之间的非语言同步 使用创新的软件和分析方法，捕捉微妙和互惠的肿瘤学相互作用 这是沟通渠道的本质。目的2是确定非言语同步的相对影响 对患者和医生的影响和沟通显示在种族一致和种族不一致 肿瘤相互作用。目的3是检查原因和后果的非言语同步在种族 不一致的肿瘤学相互作用。目标4是开发和测试一个模型，将医生和患者种族联系起来 对非语言同步的态度，反过来，互动的结果。这项研究意义重大，因为研究结果 将提高1）种族和谐和种族之间非语言交流差异的知识 不一致的肿瘤学相互作用，2）在肿瘤学相互作用期间如何传达种族态度，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贡献 待遇差异。这些知识提供了有关种族不和谐的沟通信息 互动，可用于医学教育和治疗差异干预措施的评价。的 这项研究之所以具有创新性，是因为它考察了一个影响互动的未开发的沟通渠道 结果，使用创新的方法来评估动态的，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.