Summary from Dyan Bryson: This is another example of the HOW to reach patients through their cultural filter and the WHY of cultural competency. The results of this Archives study are similar to our own experience (see Inspired Health Strategies, LLC Case Studies We learned that we could motivate a positive change in behavior but it was too soon to say that these behavior changes would result in clinical outcomes. Clinical outcomes simply take a longer period of time to study. However, the more we accept CER we can also accept short-term milestones as indicators of long-term clinical outcomes.

Published – Wed, Nov 7 2012 –

The Effect of Values Affirmation on Race-Discordant Patient-Provider Communication

By Genevra Pittman

Original abstract:

NEW YORK (Reuters Health) – A short waiting room exercise encouraging African American patients to reflect on their personal values helped improve communication between the patients and their white doctors, in a new study.

However, those patients didn’t rate their trust in their doctor or satisfaction with the appointment any higher, compared to those who didn’t do the “values affirmation” exercise.

Patients and doctors interact differently when they are of different races, compared to when both are white or both are African American, research has shown. Some of that could be due to doctors’ own unconscious racial or ethnic biases.

“Those issues play themselves out in subtle ways in how medical care gets delivered,” said Dr. Edward Havranek, the study’s lead researcher from the Denver Health Medical Center.

But so-called cultural competence training programs for doctors haven’t been shown to improve interracial doctor-patient relationships.

Another theory is that minority patients fear they’ll be judged by stereotypes – and their stress from that fear impedes communication with their doctor, whether or not the doctor is really biased.

“If black patients believe that the doctor’s going to stereotype them because of their race, they may not behave to their full potential during the visit,” said Dr. Howard Gordon, from the Jesse Brown VA Medical Center in Chicago and the University of Illinois at Chicago.

“They may feel inhibited; they may not ask questions during the visit.”

By helping minority patients focus on their own positive qualities and values, researchers believe, those patients might not be as preoccupied with the possibility of being treated differently.

Havranek’s study involved 99 African American patients with high blood pressure who had an appointment with their non-African American primary care doctor.

About half of the patients were given a questionnaire in the hour before their appointment asking them to reflect on their personal values and think about times when those values were important.

Audio recordings of the visits showed that after filling out those surveys, African American patients requested – and were provided with – a bit more information about their medical condition. Conversations with their doctors also tended to be more positive and friendly.

But there was no difference in how often doctors dominated the conversations and no more discussion about patients’ treatment or lifestyle issues after the exercise.

On post-visit patient surveys, there was no change in their stress, satisfaction or trust in their doctor, compared to patients who weren’t given the personal value questionnaires.

“It clearly wasn’t a home run. It didn’t have the major effects that we had hoped for,” Havranek told Reuters Health.

The researchers said it’s possible the positive effects they did see on patient-doctor interaction would be enough to encourage African Americans to stick to their blood pressure drugs more closely. But they weren’t able to measure that outcome in the current study, published Monday in the Archives of Internal Medicine.

Patients asking more questions “is good, but that’s all they showed. They didn’t show that their blood pressure’s better controlled. They didn’t show that they’re less likely to have a stroke, or kidney disease or heart attack,” Gordon, who studies racial disparities and patient-doctor communication but wasn’t involved in the new research, told Reuters Health.

“Theoretically if someone asks more questions, then they know more, and that will make them more likely to stick to their doctor’s (recommendations) and take their medications. And if they take their medications, their blood pressure will be better controlled,” he said. “But this study didn’t show that yet.”

The “values affirmation” intervention might have more of an effect on minority patients before they visit new specialists they don’t already know, according to Havranek.

But Gordon said how well it would work in real-life waiting rooms, where a lot of other things are going on and there are other forms to be filled out, is still an open question.

SOURCE: Archives of Internal Medicine, online November 5, 2012.