Adams A, Realpe A, Vail L, Buckingham C D, Erby L H, Roter D
Warwick Medical School, University of Warwick, Coventry, UK.
Computer Science, Aston University, Birmingham, UK.
Patient Educ Couns. 2015 Oct;98(10):1266-73. doi: 10.1016/j.pec.2015.08.019. Epub 2015 Aug 17.
To determine the impact of doctors' communication style and doctor-patient race concordance on UK African-Caribbeans' comfort in disclosing depression.
160 African-Caribbean and 160 white British subjects, stratified by gender and history of depression, participated in simulated depression consultations with video-recorded doctors. Doctors were stratified by black or white race, gender and a high (HPC) or low patient-centred (LPC) communication style, giving a full 2×2×2 factorial design. Afterwards, participants rated aspects of doctors' communication style, their comfort in disclosing depression and treatment preferences
Race concordance had no impact on African-Caribbeans' comfort in disclosing depression. However a HPC versus LPC communication style made them significantly more positive about their interactions with doctors (p=0.000), their overall comfort (p=0.003), their comfort in disclosing their emotional state (p=0.001), and about considering talking therapy (p=0.01); but less positive about considering antidepressant medication (p=0.01).
Doctors' communication style was shown to be more important than patient race or race concordance in influencing African Caribbeans' depression consultation experiences. Changing doctors' communication style may help reduce disparities in depression care.
Practitioners should cultivate a HPC style to make African-Caribbeans more comfortable when disclosing depression, so that it is less likely to be missed.
确定医生的沟通方式以及医患种族一致性对英国非裔加勒比人披露抑郁症时舒适度的影响。
160名非裔加勒比人和160名英国白人受试者，按性别和抑郁病史分层，参与了与录像医生进行的模拟抑郁症诊疗。医生按黑人或白人种族、性别以及高患者中心型（HPC）或低患者中心型（LPC）沟通方式分层，形成完整的2×2×2析因设计。之后，参与者对医生沟通方式的各个方面、他们披露抑郁症时的舒适度以及治疗偏好进行评分。
种族一致性对非裔加勒比人披露抑郁症时的舒适度没有影响。然而，与低患者中心型沟通方式相比，高患者中心型沟通方式使他们对与医生的互动（p = 0.000）、总体舒适度（p = 0.003）、披露情绪状态时的舒适度（p = 0.001）以及考虑谈话治疗（p = 0.01）的态度明显更积极；但对考虑使用抗抑郁药物的态度则没那么积极（p = 0.01）。
在影响非裔加勒比人的抑郁症诊疗体验方面，医生的沟通方式比患者种族或种族一致性更为重要。改变医生的沟通方式可能有助于减少抑郁症护理方面的差异。
从业者应培养高患者中心型沟通方式，以使非裔加勒比人在披露抑郁症时更舒适，从而降低漏诊的可能性。
