Gorbatenko-Roth Kristina, Prose Neil, Kundu Roopal V, Patterson Stavonnie
Department of Psychology, University of Wisconsin-Stout, Menomonie.
Duke University Medical Center, Durham, North Carolina.
JAMA Dermatol. 2019 Oct 1;155(10):1129-1134. doi: 10.1001/jamadermatol.2019.2063.
The availability and quality of skin and hair care for black patients in the United States has been a subject of growing interest in dermatology. There is limited understanding of the perceptions of black patients about the care they receive from dermatologists and the factors affecting their care satisfaction.
To elucidate black patients' perceptions of their dermatology experience in and outside of a skin of color clinic (SOCC).
DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional study involving a survey and focus groups was conducted including adult black patients treated in an SOCC. Recruitment was conducted April through June 2015 through clinic-posted flyers. Participants engaged in 1 of 4 focus groups on July 14, 15, 29, or 30, 2015, and completed a survey. Data were analyzed March 2016 through June 2017.
Planned outcomes of the focus groups were black patients' inductively generated themes on their perspectives and experiences in dermatology clinics. Planned outcomes of the survey were patients' ratings of SOCC and non-SOCC dermatologists in terms of interaction style, cultural awareness, and treatment satisfaction. Importance of patient-dermatologist racial concordance was a planned outcome in both measures. Given lack of existing prior research, no specific hypotheses were generated.
Of the 19 adult black patients who participated in the study, 18 (95%) were women, and the mean (SD) age was 50.0 (14.2) years. All patients reported positive experiences in the SOCC. Compared with non-SOCC dermatology treatment experiences, patients reported higher levels of overall satisfaction with SOCC dermatologists (t13 = 2.85; P = .01). Patients perceived that SOCC dermatologists were better trained to care for black patients (t13 = 4.42; P = .001); showed patients greater respect and dignity (t13 = 3.37; P = .005), as well as understanding (t13 = 2.56, P = .02); and were more trustworthy (t13 = 3.47; P = .004). The majority of the comments in the focus groups (n = 207) described 2 themes: dermatologists' interaction style (62/207; 30.0%) and knowledge about black skin and hair (42/207; 20.3%). Other themes were partnering with patients on outcomes (17/207; 8.2%), shared life experiences (14/207; 6.8%), and economic sensitivity (7/207; 3.4%). These themes accounted for a large part of the participants' discussion. Of all respondents, 71% (12/17) stated that they would prefer a black (or race concordant) dermatologist; this included 91% (10/11) of the race-concordant group and 33% (2/6) of the race-discordant group.
Participants reported that the SOCC dermatologists provided unique and uniformly beneficial care to black patients. Care satisfaction appeared most related to dermatologists' interpersonal style and specialized knowledge in care of black skin and hair. Findings suggest that black patients' dermatologic care satisfaction would increase if dermatologists underwent enhanced residency training in skin of color, cultural competency, cost-conscious care, and empathic communication skills, and if there were greater dermatology workforce diversity.
美国黑人患者皮肤和头发护理的可及性与质量一直是皮肤科领域日益受到关注的话题。对于黑人患者对皮肤科医生所提供护理的看法以及影响其护理满意度的因素，人们了解有限。
阐明黑人患者对其在肤色诊所（SOCC）内外皮肤科就诊经历的看法。
设计、背景与参与者：开展了一项横断面研究，包括一项调查和焦点小组讨论，纳入在SOCC接受治疗的成年黑人患者。2015年4月至6月通过在诊所张贴传单进行招募。参与者于2015年7月14日、15日、29日或30日参加了4个焦点小组讨论中的1个，并完成了一项调查。2016年3月至2017年6月对数据进行了分析。
焦点小组讨论的预期结局是黑人患者就其在皮肤科诊所的观点和经历归纳得出的主题。调查的预期结局是患者对SOCC和非SOCC皮肤科医生在互动方式、文化意识和治疗满意度方面的评分。患者与皮肤科医生种族匹配的重要性是两项测量指标的预期结局。鉴于此前缺乏相关研究，未提出具体假设。
参与该研究的19名成年黑人患者中，18名（95%）为女性，平均（标准差）年龄为50.0（14.2）岁。所有患者均报告在SOCC有积极的就诊体验。与非SOCC皮肤科治疗经历相比，患者报告对SOCC皮肤科医生的总体满意度更高（t13 = 2.85；P = 0.01）。患者认为SOCC皮肤科医生在照顾黑人患者方面接受了更好的培训（t13 = 4.42；P = 0.001）；对患者表现出更多的尊重和尊严（t13 = 3.37；P = 0.005），以及理解（t13 = 2.56，P = 0.02）；并且更值得信赖（t13 = 3.47；P = 0.004）。焦点小组讨论中的大多数评论（n = 207）描述了两个主题：皮肤科医生的互动方式（62/207；30.0%）以及关于黑人皮肤和头发的知识（42/207；20.3%）。其他主题包括与患者就治疗结果进行合作（17/207；8.2%）、分享生活经历（14/207；6.8%）以及经济敏感性（7/207；3.4%）。这些主题在参与者的讨论中占了很大一部分。在所有受访者中，71%（12/17）表示他们更喜欢黑人（或种族匹配）皮肤科医生；这包括种族匹配组中的91%（10/11）和种族不匹配组中的33%（2/6）。
参与者报告称，SOCC皮肤科医生为黑人患者提供了独特且一致有益的护理。护理满意度似乎与皮肤科医生的人际风格以及在黑人皮肤和头发护理方面的专业知识最为相关。研究结果表明，如果皮肤科医生在肤色护理、文化能力、注重成本的护理和共情沟通技巧方面接受强化住院医师培训，并且皮肤科劳动力更加多样化，那么黑人患者的皮肤科护理满意度将会提高。
