Empathic Communication Key to Addressing Healthcare Discrimination

The human in touch in healthcare—helping people work around care access barriers, empathic communication, and clear healthcare communication—could all help stem the tide of healthcare discrimination, according to a qualitative study published in Pediatrics.

Without those factors, discrimination and disrespect can taint the healthcare experience, something that’s especially salient for people with public insurance coverage, the study showed.

These findings come as mounting evidence proves the importance of good patient-provider communication and relationships. Better communication has been linked to better outcomes. Meanwhile, a good healthcare experience can affect hospital reimbursement in certain value-based care contracts.

“However, persistent sociodemographic disparities exist in patient experience with regard to race and ethnicity, primary language, and insurance status,” the researchers wrote in the article’s introduction.

“Factors associated with disparities in both adult and pediatric populations include patients not feeling understood, clinicians not communicating well nor spending enough time, and clinicians’ lack of culturally effective care. Racism and clinicians’ implicit biases may also play a central role in affecting patient experience.”

This most recent study offered a qualitative look into patient experiences of care in a hospital outpatient pediatric clinic, revealing that although healthcare discrimination can tarnish the overall patient experience, there are some themes that can mitigate poor experience.

“Respect and discrimination is an overarching theme that affects all aspects of the care journey, setting expectations on the basis of previous experiences which are reinforced or ameliorated during subsequent experience,” the researchers reported.

Overall, folks with public insurance were the most likely to report healthcare discrimination or disrespect, followed by Black and Hispanic interviewees and then Asian participants.

“My daughter was crying and [the nurse] came in [and stated:]’ It’s tough being a single mom. Huh?’.…I am not a single mom. Why would you assume that I’m a single mom? My husband is on his way to pick me up,” said one participant, who was Black and enrolled in public insurance.

The interviews also revealed three central themes that can still shape the overall patient and family perception of care even against the backdrop of healthcare discrimination:

• Clinician or staff mitigation of healthcare system issues
• Personal interactions with clinicians and staff
• Effective explanations of healthcare concepts and treatments

Approached effectively and empathically, these three themes can overcome a system wrought with discrimination; conversely, these themes can themselves be influenced by implicit bias and perpetuate poor patient experiences.

On the whole, parents had negative perceptions about healthcare system issues, citing problems booking appointments, traveling to the clinic, or appointment wait times.

“When you get [to the visit], you wait 20 to 30 minutes. By the time you get to the room itself, it is another 10.… So it really gets me really upset, because I come here, wait 30 minutes or an hour more, [after getting] here on time. And then, by the time you get to be seen by the doctor, it’s a 5-minute visit. And it’s like, what?” noted another parent, who identified as Hispanic and who was on public insurance.

Parents also noted when organizations made accommodations, like helping to reschedule appointments or refilling prescriptions, the report noted.

But perhaps even more influential was the role of the patient-provider interaction, with the researchers pointing out that most interviewees agreed that people are what make for a good healthcare experience.

“Several subthemes emerged that defined the qualities of the best personal interactions: interpersonal skills, professionalism, personalization, engagement with child, shared decision-making, valuing parental expertise, perception of stress, and depth of bond with clinician,” the researchers reported.

Personalized healthcare, shared decision-making, and a longitudinal family relationship with a provider all contributed to good perceptions of care.

On the other hand, parents were keenly aware of the clinician burnout problem affecting healthcare providers, noting that clinician stress contributed to a chaotic and sometimes negative atmosphere in the clinic.

Finally, healthcare providers who offered clear explanations about a child’s health or treatment plan helped shape a better care experience. Clear communication helped empower parents to take care of their children at home, the researchers pointed out, and also showed that clinicians cared enough to take the time to fully explain complex medical topics.

“Parents commented on methods of effective clinician communication, including explaining medical terminology, using diagrams or visual aids, describing reasons for testing or prescriptions, and providing clear steps for follow-up care,” the researchers said. “Parents also valued clinicians allowing ample time for their questions and providing detailed answers.”

There were some differences in preferences that fell along some racial lines, the researchers said. For example, Hispanic/Latino parents were more likely to prefer deep interpersonal connection between them and their child’s healthcare providers.

However, the researchers cautioned against viewing racial groups as monolithic.

“Although clinician awareness of differences in cultural values and perspectives between diverse patient populations is necessary, it is also crucial that patients are viewed as unique individuals, and not solely as members of a particular cultural group,” they said. “Practicing cultural humility, which includes listening to a patient’s perspectives, concerns, and values, and reflecting on one’s own biases and assumptions is essential for culturally effective care.”

The researchers suggested clinicians used the LEARN ((listen with sympathy, explain your perceptions, acknowledge and discuss the differences or similarities, recommend treatment, and negotiate agreement) model for cultural humility.

“Recent work emphasizes the feasibility and effectiveness of culturally sensitive interventions in eliminating disparities in the pediatric primary care setting,” the team concluded. “Intentional and evidence-based changes in care delivery systems may support efforts to overcome the barriers to equitable health care for all pediatric patients and their families.”