The Influence of Patient and Physician Race-Related Attitudes and Perceptions on Nonverbal Synchrony in Oncology Treatment Interactions Between Black Patients and Non-Black Physicians

Introduction: Abundant research documents Black-White disparities in the quality of patient-physician clinical communication during oncology interactions. Prior research shows that Black patients’ and non-Black physicians’ race-related attitudes and perceptions influence clinical communication and patient and physician perceptions of one another. The aim of this cross-sectional study was to determine the effects of such attitudes and perceptions on another important but understudied aspect of interpersonal communication—nonverbal synchrony. The attitudes and perceptions included non-Black physician implicit racial bias; and Black patients’ suspicion of medical care Black patients receive, trust in healthcare systems, and previous experience with discrimination. We predicted that patient and physician race-related attitudes and perceptions would be associated with various nonverbal synchrony measures during oncology interactions between Black patients and non-Black physicians. Methods: This was a secondary analysis of video-recorded cancer treatment discussions between Black patients and their non-Black physicians collected as part of a larger study. Participants included 66 Black patients and 13 non-Black physicians. Physician implicit racial bias and demographic characteristics and Black patient race-related attitudes, perceptions, and demographic characteristics were assessed prior to the interactions. Using automated motion energy analysis software, we evaluated three measures to examine nonverbal synchrony: 1) global nonverbal synchrony, 2) patient-led nonverbal synchrony, and 3) physician-led nonverbal synchrony. Results: We found positive relationships between physicians’ implicit racial bias and all measures of nonverbal synchrony. We found a positive relationship between one patient attitude (trust in healthcare systems) and one nonverbal synchrony measure (patient-led nonverbal synchrony). Conclusions: Findings provide evidence of a link between Black patient and non-Black physician race-related attitudes and perceptions and their jointly determined nonverbal synchrony during clinical interactions. Further work is needed to understand the nuances and clinical implications of this complicated relationship, and to inform potential interventions to improve communication quality and related patient outcomes.