In a novel study the authors hope will contribute to improved patient care, Richard L. Roudebush Veterans Affairs Medical Center and Regenstrief Institute researchers examine how Black patients with mental health concerns evaluate verbal and non-verbal communication during treatment.

Drawing upon information gathered in interviews with 85 Black patients that revealed significant fear of being negatively judged based on stereotypes, the authors evaluate how perceptions of racial bias influence patient engagement with their providers. The researchers also provide suggestions on how to create environments for Black and other patients in racial and ethnic minority groups that foster delivery of person-centered care as well as outlining organizational structures that reduce providers’ burnout.

“This study is one of the first to explore the actual perceptions of Black patients with mental health concerns and provides a new lens to help identify and address biases,” said Johanne Eliacin, PhD, a research scientist with Regenstrief Institute and the U.S. Department of Veterans Affairs, who led the research. “Nuanced verbal and non-verbal cues – for example, a patient’s perception that a physician is subtly talking down to him or her because of the patient’s race or social class — can generate patient negativity resulting in damaging consequences.

“There is a long history of hurt, distrust and perceived injustice in this country, so it’s normal for minority patients to have their guard up when interacting with the healthcare system,” said Dr. Eliacin. “This paper is significant because of its subject matter and especially relevant as we work to provide equitable healthcare for all.”

Patients’ perceptions of bias in healthcare are known to be associated with suboptimal care, delays in obtaining medical care, underutilization of preventive and mental health care, less adherence to recommended therapy and poorer treatment outcomes

Perceptions of bias also negatively impact the patient-provider relationship, a relationship that influences both patients’ engagement in care and quality of healthcare outcomes.

“Most healthcare providers are committed to providing good and equitable treatment to all patients regardless of their race or sexual-orientation but doctors, nurses and other clinicians are not immune to social and cultural influences that can lead to stereotyping and implicit racial bias — major contributors to healthcare disparities,” said Dr. Eliacin. “We aren’t asking providers to walk on egg shells, we are encouraging them to engage in two-way communication in order to better understand the people they serve and, ultimately, to promote health equity.”

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