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The Role of Racial Attitudes and Doctor-Patient Communication in Pain-related Racial Disparities among Urban African Americans

a PSC Research Project [ARCHIVE DISPLAY]

Investigators:   Stephen Henry, Angela Tsai Fagerlin

Our project will address knowledge gaps about the underlying causes for documented racial disparities in pain management, a common cause of suffering and lost productivity among Michigan residents. In particular, we shall investigate how racial attitudes effect doctor-patient communication and patient outcomes by evaluating pain-related discussions between doctors and black patients during video recordings of actual primary care clinic visits. Prior research suggests that racial biases are communicated nonverbally during doctor-patient interactions. We propose to build on these findings by rating affect (which comprises both verbal and nonverbal behavior) during pain-related discussions using an existing video database collected in northwest Detroit. We hypothesize that the subjective nature of pain and providers? fears of ?narcotic-seeking? patients will accentuate the effects of racial attitudes on verbal and nonverbal behavior during clinical interactions. Researchers at Wayne State University have demonstrated that providers? and patients? baseline racial attitudes affect post-visit patient satisfaction and adherence. Our project will build on these findings by using a validated system for rating affect from video-recorded clinical interactions. These ratings will allow us to test whether verbal and nonverbal communication about pain mediates the relationships between patients? and providers? racial attitudes and patient outcomes. Our proposal leverages an ongoing collaboration between investigators at Wayne State University, who collected the video data and have experience evaluating video-recorded interactions, and the University of Michigan, who have collected preliminary data about pain in the video recordings and have developed expertise measuring nonverbal communication. Our results will provide critical information about the mechanisms underlying pain-related racial disparities. This information is a necessary prerequisite for evidence-based interventions designed to ameliorate these racial disparities. Therefore we expect that our results will directly inform subsequent research for testing either provider- or patient-targeted interventions that address pain-related health disparities in Michigan.

Funding Period: 01/01/2011 to 06/30/2012

Country of Focus: USA

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