Racial disparities in cancer outcomes are well documented in the scientific literature. Though biological differences in African-American and Caucasian populations are being investigated, there is a growing body of evidence that indicates distinct treatment patterns based on race may account for a significant part of the outcome differences. The literature is not consistent regarding whether racially distinct treatment patterns are due to patient preferences or physician biases.
New data suggest that problems in doctor-patient communication may account for at least some of the disparity. Studies show patients make most medical decisions based on some degree of consultation with their physician and that race influences a patient's perception of the quality and quantity of information gathered from the physician consultation. In particular, patients perceive better communication with and support from physicians of the same race.
Led by Howard S. Gordon, M.D. of the Michael E. DeBakey Veterans Affairs Medical Center and the Baylor College of Medicine in Houston, researchers investigated how race influenced doctor-patient communication in the setting of patients with lung cancer and suspicious lung lesions. The investigators reviewed, transcribed, and analyzed audiotapes from 137 separate doctor-patient consultations.
They found that the degree of patient engagement with the physician impacted the frequency of information provided by physicians but race did not, despite the finding that African-Americans received less information. While there was no difference in the amount of information when that information was initiated by the physician, there were differences in the amount of physician information provided when prompted by the patient. African-Americans were less likely than Caucasians to ask questions or raise concerns to their physicians and to bring a friend or family member to the appointment. However, when doctors and patients were of the same race, any disparity in physician information provided disappeared.
"These findings are notable," conclude the researchers, "while not directly negating the possibility that racial disparities in care are due to doctor bias or patient preferences, they suggest that disparities in medical care are related in part to the communicative dynamics of the encounter, particularly the degree to which patients are actively involved."