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

患者与医生的种族不一致与患者的不满和不信任密切相关 医生，这进一步与较差的治疗依从性和次优的医疗保健利用相关。 这带来了严重的公共卫生挑战，因为大约80-90%的黑人患者看医生 来自不同的种族群体。最近发现，患者的不满和不信任尤其 当医生对美国黑人持有高水平的自动、内隐偏见时，这种偏见会被放大，这表明， 医生的内隐种族偏见会影响医生在医疗互动中的沟通行为， 最后是黑人患者的结局。这项研究的总体目标是确定医生的 在医疗互动过程中的沟通行为与医生的内隐 种族偏见和黑人患者的直接（满意度，信任）以及临床重要的长期 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， 黑人2型糖尿病（T2 DM）患者，因为黑人T2 DM患者的不依从性 尤其普遍。此外，已经发现患者-医生沟通质量预测 患者依从T2 DM治疗方案。我们将使用混合方法设计， 归纳推理的优势，探讨哪些医生的沟通行为，在医疗 从黑人患者的角度和演绎推理来确定理论上和 临床重要行为我们的目的是：目的1）探索哪些医生沟通行为 在医疗互动过程中，黑人患者对医疗互动的看法是消极的还是积极的，以及为什么;目的2）识别 目标1中确定的哪些医生沟通行为与医生的内隐种族 偏见;和目标3）检查医生的隐性种族偏见如何影响黑人患者的满意度，信任， 通过医生的沟通行为，坚持和医疗保健利用。我们将采用创新的 整合多种方法（访谈、视频记录的医疗互动、调查、病历 评论）。这项研究的结果将使研究人员能够识别医生的沟通行为 在医疗互动过程中，这是有问题的，有利于即时和长期的结果， 在黑人T2 DM患者中。需要这种能力来开发个性化的、有针对性的 沟通技能培训和其他干预措施，目标是患者-提供者互动，以克服种族歧视。 糖尿病治疗依从性、结果及其他方面的差异。此外，在完成此 项目，我们将有一个医疗互动，涉及黑人患者编码系统（MIBPCS），不同于 现有的病人-医生通信编码系统的优点在于：（1）将集中于医生的通信 在医疗互动过程中的行为，可以预测黑人患者的结果;（2）放置一个 从病人的角度来看，这是前所未有的。

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.