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A Social Psychological Approach to Improving the Outcomes of Racially Discordant Medical Interactions

Journal of General Internal Medicine volume 28, pages 1143–1149 (2013)Cite this article

Abstract

BACKGROUND

Medical interactions between Black patients and non-Black physicians are less positive and productive than racially concordant ones and contribute to racial disparities in the quality of health care.

OBJECTIVE

To determine whether an intervention based on the common ingroup identity model, previously used in nonmedical settings to reduce intergroup bias, would change physician and patient responses in racially discordant medical interactions and improve patient adherence.

IINTERVENTION

Physicians and patients were randomly assigned to either a common identity treatment (to enhance their sense of commonality) or a control (standard health information) condition, and then engaged in a scheduled appointment.

DESIGN

Intervention occurred just before the interaction. Patient demographic characteristics and relevant attitudes and/or behaviors were measured before and immediately after interactions, and 4 and 16 weeks later. Physicians provided information before and immediately after interactions.

PARTICIPANTS

Fourteen non-Black physicians and 72 low income Black patients at a Family Medicine residency training clinic.

MAIN MEASURES

Sense of being on the same team, patient-centeredness, and patient trust of physician, assessed immediately after the medical interactions, and patient trust and adherence, assessed 4 and 16 weeks later.

KEY RESULTS

Four and 16 weeks after interactions, patient trust of their physician and physicians in general was significantly greater in the treatment condition than control condition. Sixteen weeks after interactions, adherence was also significantly greater.

CONCLUSIONS

An intervention used to reduce intergroup bias successfully produced greater Black patient trust of non-Black physicians and adherence. These findings offer promising evidence for a relatively low-cost and simple intervention that may offer a means to improve medical outcomes of racially discordant medical interactions. However, the sample size of physicians and patients was small, and thus the effectiveness of the intervention should be further tested in different settings, with different populations of physicians and other health outcomes.

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REFERENCES

  1. Chen FM, Fryer GE, Phillips RL, Wilson E, Pathman DE. Patients’ beliefs about racism, preferences for physician race, and satisfaction with care. Ann Fam Med. 2005;3:139–143.

    Article  Google Scholar 

  2. Cooper-Patrick L, Gallo JJ, Gonzales JJ, et al. Race, gender, and partnership in the patient–physician relationship. JAMA J Am Med Assoc. 1999;282(6):583–589.

    Article  CAS  Google Scholar 

  3. Johnson RL, Roter D, Powe NR, Cooper LA. Patient race/ethnicity and quality of patient-physician communication during medical visits. Am J Public Health. 2004;94(12):2084–2090.

    PubMed  Article  Google Scholar 

  4. Oliver MN, Goodwin MA, Gotler RS, Gregory PM, Stange KC. Time use in clinical encounters: are African-American patients treated differently? J Natl Med Assoc. 2001;93(10):380–385.

    PubMed  CAS  Google Scholar 

  5. Siminoff LA, Graham GC, Gordon NH. Cancer communication patterns and the influence of patient characteristics: disparities in information-giving and affective behaviors. Patient Educ Counsel. 2006;62(3):355–360.

    Article  Google Scholar 

  6. Eggly S, Penner LA, Harper FW, et al. Perceptions of information provided by oncologists in clinical interactions with black and white patients/companions. Paper presented at: American Association for Cancer Research Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; October; 2010.

  7. Cooper LA, Roter DL, Carson KA, et al. The associations of clinicians’ implicit attitudes about race with medical visit communication and patient ratings of interpersonal care. Am J Public Health. 2012;102(5):979–987.

    PubMed  Article  Google Scholar 

  8. Penner LA, Dovidio JF, Edmondson D, et al. The experience of discrimination and Black–White health disparities in medical care. J Black Psychol. 2009;35:180–203.

    Article  Google Scholar 

  9. Penner LA, Dovidio JF, West TW, et al. Aversive racism and medical interactions with Black patients: a field study. J Exp Soc Psychol. 2010;46:436–440.

    PubMed  Article  Google Scholar 

  10. van Ryn M, Saha S. Exploring unconscious bias in disparities research and medical education. JAMA J Am Med Assoc. 2011;306(9):995–996.

    Article  Google Scholar 

  11. Dovidio JF, Penner LA, Albrecht TL, Norton WE, Gaertner SL, Shelton JN. Disparities and distrust: the implications of psychological processes for understanding racial disparities in health and health care. Soc Sci Med. 2008;67:478–486.

    PubMed  Article  Google Scholar 

  12. Moskowitz D, Thom DH, Guzman D, Penko J, Miaskowski C, Kushel M. Is primary care providers’ trust in socially marginalized patients affected by race? J Gen Intern Med. 2011;26(8):846–851.

    PubMed  Article  Google Scholar 

  13. Doescher MP, Saver BG, Franks P, Fiscella K. Racial and ethnic disparities in perceptions of physician style and trust. Arch Fam Med. 2000;9(10):1156–1163.

    PubMed  Article  CAS  Google Scholar 

  14. Halbert CH, Armstrong K, Gandy OH, Shaker L. Racial differences in trust in health care providers. Arch Intern Med. 2006;166:896–901.

    PubMed  Article  Google Scholar 

  15. Johnson RL, Saha S, Arbelaez JJ, Beach MC, Cooper LA. Racial and ethnic differences in patient perceptions of bias and cultural competence in health care. J Gen Intern Med. 2004;19:101–110.

    PubMed  Article  Google Scholar 

  16. Gordon HS, Street RL Jr, Sharf BF, Kelly PA, Souchek J. Racial differences in trust and lung cancer patients’ perceptions of physician communication. J Clin Oncol Offic J Am Soc Clin Oncol. 2006;24(6):904–909.

    Article  Google Scholar 

  17. Gaertner SL, Dovidio JF. Reducing intergroup bias: the common ingroup identity model. New York: Psychology Press; 2000.

    Google Scholar 

  18. Gaertner SL, Dovidio JF. A common ingroup identity: a categorization-based approach for reducing intergroup bias. In: Nelson TD, ed. Handbook of prejudice, stereotyping, and discrimination. New York: Psychology Press; 2009:489–505.

    Google Scholar 

  19. Crisp RJ, Turner RN, Hewstone M. Common ingroups and complex identities: routes to reducing bias in multiple category contexts. Group Dynam Theor Res Pract. 2010;14(1):32–46.

    Article  Google Scholar 

  20. Guerra R, Rebelo M, Monteiro MB, et al. How should intergroup contact be structured to reduce bias among majority and minority group children? Group Process Intergroup Relat. 2010;13(4):445–460.

    Article  Google Scholar 

  21. González R, Manzi J, Noor M. Intergroup forgiveness and reparation in Chile: the role of identity and intergroup emotions. In: Tropp LR, Mallett RK, eds. Moving beyond prejudice reduction: pathways to positive intergroup relations. Washington, DC: American Psychological Association; 2011:221–239.

    Chapter  Google Scholar 

  22. Wohl MJA, Branscombe NR. Forgiveness and collective guilt assignment to historical perpetrator groups depend on level of social category inclusiveness. J Personal Soc Psychol. 2005;88(2):288–303.

    Article  Google Scholar 

  23. Brigham JC. College students’ racial attitudes. J Appl Soc Psychol. 1993;23(23):1933–1967.

    Article  Google Scholar 

  24. McConahay JB. Modern racism, ambivalence, and the modern racism scale. In: Dovidio JF, Gaertner SL, eds. Prejudice, discrimination, and racism. San Diego: Academic; 1986:91–125.

    Google Scholar 

  25. Greenwald AG, Poehlman TA, Uhlmann EL, Banaji MR. Understanding and using the implicit association test: III. Meta-analysis of predictive validity. J Personal Soc Psychol. 2009;97:17–41.

    Article  Google Scholar 

  26. Hays RD, Kravitz RL, Mazel RM, Sherbourne CD. The impact of patient adherence on health outcomes for patients with chronic disease in the medical outcomes study. J Behav Med. 1994;17(4):347–360.

    PubMed  Article  CAS  Google Scholar 

  27. Brown TN. Measuring self-perceived racial and ethnic discrimination in social surveys. Sociol Spectr. 2001;21(3):377–392.

    Article  Google Scholar 

  28. Dugan E, Trachtenberg F, Hall MA. Development of abbreviated measures to assess patient trust in a physician, a health insurer, and the medical profession. BMC Health Services Research. 2005;5.

  29. Stewart MA, Brown JB, Donner A, et al. The impact of patient-centered care on outcomes. J Fam Pract. 2000;49:796–804.

    PubMed  CAS  Google Scholar 

  30. PROCESS [computer program]. 2012.

  31. Epstein RM, Street RL. Patient-centered communication in cancer care: promoting healing and reducing suffering. Bethesda, MD: National Cancer Institute; 2007.

    Google Scholar 

  32. Derby DC, Haan A, Wood K. Data quality assurance: an analysis of patient non-response. Int J Health Care Qual Assur. 2011;24(3):198–210.

    PubMed  Article  Google Scholar 

  33. Mazor KM, Clauser BE, Field T, Yood RA, Gurwitz JH. A demonstration of the impact of response bias on the results of patient satisfaction surveys. Heal Serv Res. 2002;37(5):1403–1417.

    Article  Google Scholar 

  34. Dovidio JF, Gaertner SL, Validzic A, Matoka K, Johnson B, Frazier S. Extending the benefits of recategorization: evaluations, self-disclosure, and helping. J Exp Soc Psychol. 1997;33(4):401–420.

    PubMed  Article  Google Scholar 

  35. Park B, Rothbart M. Perception of out-group homogeneity and levels of social categorization: memory for the subordinate attributes of in-group and out-group members. J Personal Soc Psychol. 1982;42(6):1051–1068.

    Article  Google Scholar 

  36. Foddy M, Platow MJ, Yamagishi H. Group-based trust in strangers: the role of stereotypes and expectations. Psychol Sci. 2009;20:419–422.

    PubMed  Article  Google Scholar 

  37. Vorauer JD. An information search model of evaluative concerns in intergroup interaction. Psychol Rev. 2006;113(4):862–886.

    PubMed  Article  Google Scholar 

  38. Mackie DM, Devos T, Smith ER. Intergroup emotions: explaining offensive action tendencies in an intergroup context. J Personal Soc Psychol. 2000;79:602–616.

    Article  CAS  Google Scholar 

  39. Hewstone M. The ‘ultimate attribution error’? A review of the literature on intergroup causal attribution. Eur J Soc Psychol. 1990;20(4):311–335.

    Article  Google Scholar 

  40. Hing E, Lin S. Role of international medical graduates providing office-based medical care: United States, 2005–2006. NCHS Data Brief. 2009;13:1–8.

    PubMed  Google Scholar 

  41. Sabin JA, Rivara FP, Greenwald AG. Physician implicit attitudes and stereotypes about race and quality of medical care. Med Care. 2008;46:678–685.

    PubMed  Article  Google Scholar 

  42. Benkert R, Peters RM, Clark R, Keves-Foster K. Effects of perceived racism, cultural mistrust and trust in providers on satisfaction with care. J Natl Med Assoc. 2006;98:1532–1540.

    PubMed  Google Scholar 

  43. Green AR, Carney DR, Pallin DJ, et al. Implicit bias among physicians and its predictions of thrombolysis decisions for Black and White patients. J Gen Intern Med. 2007;22:1231–1238.

    PubMed  Article  Google Scholar 

  44. Hagiwara N, Penner LA, Eggly S, Albrecht TL. Perceived discrimination, implicit bias, and adherence to physician recommendations. Paper presented at: The Science of Research on Discrimination and Health Conference, Bethesda, MD; 2011.

  45. Blair IV. Doctor’s implicit bias predicts Black patients’ evaluations. Symposium on The Role of Stereotypes and Prejudice in Health. Aassociation for Psychological Science. Chicago Illinois; 2012.

  46. Smedley BD, Stith AY, Nelson AR. Unequal treatment: Confronting racial and ethnic disparities in health care. In: Medicine Io, (ed). Washington DC: National Academies Press; 2003.

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Acknowledgements

This research was supported by a grant to the first author from the National Institute of Child Health and Development (1R21HD050445001A1) and a SAGES Award from the Society for the Psychological Study of Social issues, grants to the last author from the National Cancer Institute (U01CA114583, 1U54CA154606-01), a grant from the National Science Foundation (BCS-0613218) to Samuel L. Gaertner and John F. Dovidio, and a NIH Grant RO1HL 0856331-0182 and a NIDA Grant 1R01DA029888-01 to John F. Dovidio. Prior Presentation: Society for Personality and Social Psychology, January 27, 2010, Tampa, Florida.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

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Authors and Affiliations

  1. Population Studies and Disparities Research Program, Karmanos Cancer Institute, 4100 John R. Mailcode: MM03CB, Detroit, MI, 485201, USA

    Louis A. Penner PhD, Nao Hagiwara PhD & Terrance L. Albrecht PhD

  2. Department of Oncology, Wayne State University, Detroit, MI, USA

    Louis A. Penner PhD, Nao Hagiwara PhD & Terrance L. Albrecht PhD

  3. Department of Psychology, University of Delaware, Newark, DE, USA

    Samuel Gaertner PhD

  4. Department of Psychology, Yale University, New Haven, CT, USA

    John F. Dovidio PhD

  5. Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI, USA

    John Porcerelli PhD & Tsveti Markova MD

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  1. Louis A. Penner PhD
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  2. Samuel Gaertner PhD
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  7. Terrance L. Albrecht PhD
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Correspondence to Louis A. Penner PhD.

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Penner, L.A., Gaertner, S., Dovidio, J.F. et al. A Social Psychological Approach to Improving the Outcomes of Racially Discordant Medical Interactions. J GEN INTERN MED 28, 1143–1149 (2013). https://doi.org/10.1007/s11606-013-2339-y

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KEY WORDS

  • common ingroup identity model
  • intergroup bias
  • racially discordant medical interactions