Gordon Howard S, Street Richard L, Sharf Barbara F, Kelly P Adam, Souchek Julianne
Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA.
J Clin Oncol. 2006 Feb 20;24(6):904-9. doi: 10.1200/JCO.2005.03.1955.
Black patients report lower trust in physicians than white patients, but this difference is poorly studied. We examined whether racial differences in patient trust are associated with physician-patient communication about lung cancer treatment.
Data were obtained for 103 patients (22% black and 78% white) visiting thoracic surgery or oncology clinics in a large Southern Veterans Affairs hospital for initial treatment recommendation for suspicious pulmonary nodules or lung cancer. Questionnaires were used to determine patients' perceptions of the quality of the physicians' communication and were used to assess patients' previsit and postvisit trust in physician and trust in health care system. Patients responded on a 10-point scale.
Previsit trust in physician was statistically similar in black and white patients (mean score, 8.2 v 8.3, respectively; P = .80), but black patients had lower postvisit trust in physician than white patients (8.0 v 9.3, respectively; P = .02). Black patients, compared with white patients, judged the physicians' communication as less informative (7.3 v 8.5, respectively; P = .03), less supportive (8.1 v 9.3, respectively; P = .03), and less partnering (6.4 v 8.2, respectively; P = .001). In mixed linear regression analysis, controlling for clustering of patients by physician, patients' perceptions of physicians' communication were statistically significant (P < .005) predictors of postvisit trust, although patient race, previsit trust, and patient and visit characteristics were not significant (P > .05) predictors.
Perceptions that physician communication was less supportive, less partnering, and less informative accounted for black patients' lower trust in physicians. Our findings raise concern that black patients may have lower trust in their physicians in part because of poorer physician-patient communication.
黑人患者报告称对医生的信任度低于白人患者，但这一差异的研究较少。我们研究了患者信任方面的种族差异是否与肺癌治疗的医患沟通有关。
收集了103例患者（22%为黑人，78%为白人）的数据，这些患者前往南方一家大型退伍军人事务医院的胸外科或肿瘤科诊所，就可疑肺结节或肺癌进行初始治疗建议。使用问卷来确定患者对医生沟通质量的看法，并用于评估患者就诊前和就诊后对医生的信任以及对医疗保健系统的信任。患者以10分制进行回答。
黑人患者和白人患者就诊前对医生的信任在统计学上相似（平均得分分别为8.2和8.3；P = 0.80），但黑人患者就诊后对医生的信任低于白人患者（分别为8.0和9.3；P = 0.02）。与白人患者相比，黑人患者认为医生的沟通提供的信息较少（分别为7.3和8.5；P = 0.03）、支持性较差（分别为8.1和9.3；P = 0.03）且合作性较差（分别为6.4和8.2；P = 0.001）。在混合线性回归分析中，在控制了患者按医生聚类的情况下，患者对医生沟通的看法是就诊后信任的统计学显著（P < 0.005）预测因素，尽管患者种族、就诊前信任以及患者和就诊特征并非显著（P > 0.05）预测因素。
认为医生沟通支持性较差、合作性较差且信息较少的看法导致了黑人患者对医生的信任度较低。我们的研究结果令人担忧，黑人患者对医生的信任度较低可能部分是由于医患沟通较差。
