Disparities in skin cancer outcomes have been demonstrated along racial lines in previous studies. This study examines the role of interpersonal communication in a clinical setting on these disparities.
Racial minorities in the United States tend to exhibit an increased risk of poor outcomes from skin cancer. Communication between the physician and patient can impact further outcomes in a number of ways, and physicians may tend to engage in disparate types of communication with patients from certain racial or ethnic groups.
Past studies have focused on possible socioeconomic factors that may contribute to worsening outcomes for non-White patients with skin cancers. A recent study, published in JAAD International, attempts to understand whether or not physician and patient interactions can contribute to this disparity. In particular, the study addresses whether or not physicians show respect, listen carefully, and communicate in a way that is conducive to ongoing treatment goals when dealing with patients in certain ethnic or racial categories.
Patient Perceptions of Respect in Clinical Settings
Patients were divided into a non-Hispanic White (NHW) group and a racial and ethnic minority group, which included individuals self-reporting as Hispanic, Black, Asian, Native American, Alaskan Native, or multiracial. The racial and ethnic minority group was looked at collectively because they all exhibit worse skin cancer outcomes. This also allowed for the inclusion of racial groups with small sample sizes.
Patients’ responses to various survey questions regarding their interaction with physicians were used as outcome variables in this study. These included questions about how doctors show respect, listen, and explain. These covaried with age, sex, insurance type, cancer type, year, and health status. Univariable and multivariable logistic regression models were used to compare variables between groups, and sample weights were used to account for complex survey design as well as to produce nationally representative prevalence estimates.
Study participants in the racial and ethnic minority group were less likely to indicate that doctors showed respect, listened, or explained, compared to patients in the NHW group. When adjusting for age, sex, health status, insurance type, and survey year, the racial and ethnic minority group showed 44% lower odds of reporting doctors showing respect, 36% lower odds of reporting that doctors listened, and 53% lower odds of reporting doctors explaining to them in clinical settings. Some association was found between doctors explaining and showing respect in the racial and ethnic minority group.
Disparities in Respect from Physicians Reinforce the Systemic Nature of Health Disparities as a Whole
The disparities found in this study are consistent with past studies indicating disparities among these groups when considering other aspects of care. The authors note that this underscores the systemic nature of these disparities, which persist in many domains. Past studies have shown correlations between patient–physician communication and health outcomes, although the mechanisms involved are still being studied. Still, this suggests some relationship between these interpersonal factors and outcomes, although more research is needed to discover and suggest specific interventions.
Fahmy, L. M., Schreidah, C. M., & Geskin, L. J. (2023). Racial and ethnic disparities in the perception of respect from physicians among skin cancer patients in the United States. JAAD International, 11, 78–82. https://doi.org/10.1016/j.jdin.2023.01.009