Gordon Howard S, Street Richard L, Sharf Barbara F, Souchek Julianne
Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois, USA.
Cancer. 2006 Sep 15;107(6):1313-20. doi: 10.1002/cncr.22122.
Whether doctor-patient communication differs by race was investigated in patients with pulmonary nodules or lung cancer.
Eligible patients (n = 137) had pulmonary nodules or lung cancer and were seen in thoracic surgery or oncology clinics for initial treatment recommendations at a large southern Veterans Affairs Medical Center from 2001-2004. Doctor-patient consultations were audiotaped. Audiotapes were transcribed, unitized into utterances, and utterances were coded as doctors' information-giving or patients' and companions' active participation (asking questions, expressing concerns, and making assertions). Data were compared by patient race and doctor-patient racial concordance using t-tests or chi-square tests as appropriate. Mixed linear regression was used to determine the independent predictors of doctor's information-giving after controlling for clustering of patients by doctor.
Patient age, gender, marital status, clinical site, and health status were similar by race (P > .20), but black patients were somewhat less likely to have education beyond high school and to bring a companion to the visit (P = .06) than white patients. Black patients and their companions received significantly less information from doctors (49.3 vs. 87.3 mean utterances; P < .001) and produced significantly fewer active participation utterances (21.4 vs. 37.2; P < .001) than white patients. In mixed regression analyses, after adjusting for patients' and companions' participation, clustering by doctor, and other factors, race no longer predicted information-giving (P = .54). Patients in racially discordant interactions received significantly less information and were significantly less active participants (P < .001) when compared with patients in racially concordant interactions, and after controlling for patients' participation and other factors using mixed regression, racial discordance did not predict information-giving.
The results indicate a pattern of communication that may perpetuate patient passivity and limited information exchange where black patients and patients in discordant interactions do less to prompt doctors for information and doctors in turn provide less information to these patients.
在患有肺结节或肺癌的患者中，研究了医患沟通是否因种族而异。
符合条件的患者（n = 137）患有肺结节或肺癌，2001年至2004年期间在南方一家大型退伍军人事务医疗中心的胸外科或肿瘤诊所接受初始治疗建议。医患咨询进行了录音。录音被转录、按话语单元化，话语被编码为医生提供信息或患者及其同伴的积极参与（提问、表达担忧和发表声明）。根据患者种族和医患种族一致性，使用t检验或卡方检验对数据进行比较。在控制了医生对患者的聚类后，使用混合线性回归来确定医生提供信息的独立预测因素。
患者的年龄、性别、婚姻状况、临床地点和健康状况在种族上相似（P > 0.20），但黑人患者高中以上学历的可能性和带同伴就诊的可能性略低于白人患者（P = 0.06）。与白人患者相比，黑人患者及其同伴从医生那里获得的信息明显更少（平均话语数为49.3对87.3；P < 0.001），并且产生的积极参与话语明显更少（21.4对37.2；P < 0.001）。在混合回归分析中，在调整了患者及其同伴的参与、医生聚类和其他因素后，种族不再预测信息提供情况（P = 0.54）。与种族一致互动中的患者相比，种族不一致互动中的患者获得的信息明显更少，并且积极参与度明显更低（P < 0.001）；在使用混合回归控制了患者的参与和其他因素后，表示种族不一致并不能预测信息提供情况。
结果表明了一种沟通模式，这种模式可能会使患者的被动性和有限的信息交流持续存在，即黑人患者和处于不一致互动中的患者在促使医生提供信息方面做得较少，而医生反过来向这些患者提供的信息也较少。
