1 BioCruces Bizkaia Health Research Institute, Barakaldo, Spain.
2 IKERBASQUE, Basque Foundation for Science, Bilbao, Spain.
J Womens Health (Larchmt). 2019 May;28(5):612-620. doi: 10.1089/jwh.2018.6961. Epub 2018 Nov 29.
Patient gender and race, and physician-patient communication are associated with clinical outcomes. To understand the role of these factors in the diagnosis of colorectal cancer (CRC) during primary care visits as measured by appropriate outcome. Caucasian and African American unannounced standardized patients (USPs) of both genders presented to 207 primary care physicians (PCPs) from community and academic practices in Ohio and Virginia as new patients with CRC symptoms. PCPs were blinded to the diagnosis. Physician subjects consented to audiotaping the encounter. Medical records were obtained. Communication elements were coded by trained observers and appropriate visit outcomes were coded from the medical record and audiofiles, defined as (1) recommendation for colonoscopy/sigmoidoscopy/fecal occult blood test (FOBT) or (2) referral to gastroenterologist. A total of 141 of 367 USP visits (38%) resulted in appropriate clinical outcomes. Patient race was not associated with outcome, but being a male USP was (χ = 4.12, = 0.04). Relational communication was represented as a latent variable with seven indicators (alpha = 0.84) and was independently associated with outcome (beta = 0.15; = 0.025). After controlling for clustered sampling, relational communication, and race, structural equational modeling indicated that female USPs were less likely to have an appropriate clinical visit outcome (beta = -0.13; = 0.033). Using a novel and innovative methodology capturing PCP behaviors during real-time clinician-patient interaction, appropriate clinical outcome was independently associated with being male and PCP relational communication factors such as encouraging patient communication, being engaged and expressive in the physician-patient conversation, and appearing friendly and sincere. There are persistent biases in the delivery of health care to female patients and further research into targeted communication skills programs may be warranted.
患者性别和种族以及医患沟通与临床结果相关。为了了解这些因素在初级保健就诊期间对结直肠癌 (CRC) 诊断的作用，我们使用适当的结果来衡量。我们招募了来自俄亥俄州和弗吉尼亚州社区和学术实践的 207 名初级保健医生 (PCP)，让他们接诊作为 CRC 症状新患者的白人和非裔美国未事先通知的标准化患者 (USP)，无论男女。PCP 对诊断结果不知情。医生同意对就诊过程进行录音。我们获取了医疗记录。受过培训的观察员对沟通要素进行了编码，并从医疗记录和音频文件中获取了适当的就诊结果，结果定义为 (1) 推荐进行结肠镜检查/乙状结肠镜检查/粪便潜血试验 (FOBT) 或 (2) 转介给胃肠病学家。在总共 367 次 USP 就诊中，有 141 次（38%）取得了适当的临床结果。患者种族与结果无关，但男性 USP 与之相关（χ²=4.12，p=0.04）。关系型沟通表现为一个具有七个指标的潜在变量（α=0.84），并且与结果独立相关（β=0.15，p=0.025）。在控制聚类抽样、关系型沟通和种族后，结构方程模型表明，女性 USP 更有可能出现不合适的临床就诊结果（β=-0.13，p=0.033）。使用一种新颖且创新的方法，在实时医患互动中捕捉 PCP 行为，我们发现，适当的临床结果与医生是男性以及与医患沟通相关的因素（如鼓励患者交流、在医患对话中积极投入和表达、表现友好和真诚）独立相关。在向女性患者提供医疗保健方面存在持续的偏见，可能需要进一步研究有针对性的沟通技巧方案。
