Context Black patients are more likely than white patients to die in the intensive care unit with life-sustaining treatments. Differences in patient- and/or surrogate-provider communication may contribute to this phenomenon. Objectives To test whether hospital-based physicians use different verbal and/or nonverbal communication with black and white simulated patients and their surrogates. Methods We conducted a randomized factorial trial of the relationship between patient race and physician communication using high-fidelity simulation. Using a combination of probabilistic and convenience sampling, we recruited 33 hospital-based physicians in western Pennsylvania who completed two encounters with prognostically similar, critically and terminally ill black and white elders with identical treatment preferences. We then conducted detailed content analysis of audio and video recordings of the encounters, coding verbal emotion-handling and shared decision-making behaviors, and nonverbal behaviors (time interacting with the patient and/or surrogate, with open vs. closed posture, and touching the patient and physical proximity). We used a paired t-test to compare each subjects' summed verbal and nonverbal communication scores with the black patient compared to the white patient. Results Subject physicians' verbal communication scores did not differ by patient race (black vs. white: 8.4 vs. 8.4, P-value = 0.958). However, their nonverbal communication scores were significantly lower with the black patient than with the white patient (black vs. white: 2.7 vs. 2.9, P-value 0.014). Conclusion In this small regional sample, hospital-based physicians have similar verbal communication behaviors when discussing end-of-life care for otherwise similar black and white patients but exhibit significantly fewer positive, rapport-building nonverbal cues with black patients.
Bibliographical noteFunding Information:
This work was funded by research grants awarded to Dr. Barnato by the American Cancer Society (PEP-08- 276-01-PC2) and the National Cancer Institute (R21 CA139264). Dr. Elliott was supported by the University of Pittsburgh Medical Center (UPMC) Clinical Scientist Track. None of the authors have financial conflicts of interest relevant to the current work. The authors thank many people for their contributions: the emergency physicians, hospitalists, and intensivists who volunteered their time for this study; Cindy Bryce, PhD, Julie Downs, PhD, Robert Arnold, MD, Judith Lave, PhD, and Derek Angus, MD, MPH, for their intellectual contributions and obtaining funding; Tom Dongilli, John Lutz, Christine Barton, and Jon Mazur at WISER for material and technical support; Courtney Sperlazza, Mandy Holbrook, Julie Goldstein, and Jonathan Scholl for research assistance; Demetria Marsh of Marsh Professional Simulators and additional actors Peg Wietharn, John Roell, Jackie Jonas, David Early, Bob Roberts, Miyoshi Anderson, and Jonas Chaney; Judith Tate, RN, and Marci Nilsen, RN, for "playing" bedside nurses; Douglas Landsittel, PhD, and Elan Cohen, MS, for statistical consultation; and Lillian Emlet, MD and Anthony Back, MD, for case development and review.
This work was funded by research grants awarded to Dr. Barnato by the American Cancer Society ( PEP-08-276-01-PC2 ) and the National Cancer Institute ( R21 CA139264 ). Dr. Elliott was supported by the University of Pittsburgh Medical Center (UPMC) Clinical Scientist Track. None of the authors have financial conflicts of interest relevant to the current work.
- provider behavior
- terminal care