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Impact of Perceived Discrimination in Healthcare on Patient-Provider Communication

Hausmann, Leslie R. M. PhD*,†; Hannon, Michael J. MA*,†; Kresevic, Denise M. RN, PhD; Hanusa, Barbara H. PhD*,†; Kwoh, C. Kent MD*,†; Ibrahim, Said A. MD, MPH§,∥

doi: 10.1097/MLR.0b013e318215d93c
Original Articles

Background The impact of patients' perceptions of discrimination in healthcare on patient-provider interactions is unknown.

Objective To examine association of past perceived discrimination with subsequent patient-provider communication.

Research Design Observational cross-sectional study.

Subjects African-American (N=100) and white (N=253) patients treated for osteoarthritis by orthopedic surgeons (N=63) in 2 Veterans Affairs facilities.

Measures Patients were surveyed about past experiences with racism and classism in healthcare settings before a clinic visit. Visits were audio-recorded and coded for instrumental and affective communication content (biomedical exchange, psychosocial exchange, rapport-building, and patient engagement/activation) and nonverbal affective tone. After the encounter, patients rated visit informativeness, provider warmth/respectfulness, and ease of communicating with the provider. Regression models stratified by patient race assessed the associations of racism and classism with communication outcomes.

Results Perceived racism and classism were reported by more African-American patients than by white patients (racism: 70% vs. 26% and classism: 73% vs. 53%). High levels of perceived racism among African-American patients was associated with less positive nonverbal affect among patients [β=−0.41, 95% confidence interval (CI)=−0.73 to −0.09] and providers (β=−0.34, 95% CI=−0.66 to −0.01) and with low patient ratings of provider warmth/respectfulness [odds ratio (OR)=0.19, 95% CI=0.05-0.72] and ease of communication (OR=0.22, 95% CI=0.07-0.67). Any perceived racism among white patients was associated with less psychosocial communication (β=−4.18, 95% CI=−7.68 to −0.68), and with low patient ratings of visit informativeness (OR=0.40, 95% CI=0.23-0.71) and ease of communication (OR=0.43, 95% CI=0.20-0.89). Perceived classism yielded similar results.

Conclusions Perceptions of past racism and classism in healthcare settings may negatively impact the affective tone of subsequent patient-provider communication.

*VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion

University of Pittsburgh, School of Medicine, Pittsburgh, PA

Louis Stokes DVA Medical Center, University Hospitals Case Medical Center, Cleveland, OH

§Philadelphia VA Medical Center, Center for Health Equity Research and Promotion

University of Pennsylvania School of Medicine, Philadelphia, PA

Reprints: Leslie R. M. Hausmann, PhD, VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, Pittsburgh, PA. e-mail: leslie.hausmann@gmail.com.

© 2011 Lippincott Williams & Wilkins, Inc.