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Medical Care:
doi: 10.1097/MLR.0b013e318215d93c
Original Articles

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§,∥

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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.

© 2011 Lippincott Williams & Wilkins, Inc.


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