Reminder of values helps African–Americans interact with physicians

Completing a values-affirmation task before a scheduled visit to the primary care physician could improve communications between African-American patients and their providers, show the results of a randomized, controlled study.

Compared with a sham exercise, individuals who completed the intervention involving a short writing exercise, requested and provided more information from or to their physician, and were more interested, friendly, responsive, interactive, and respectful, report the researchers.

Completing the values-affirmation exercise also reduced the likelihood of "negative mood" behaviors such as being depressed and distressed during the physician visit compared with completing the sham exercise.

"Because visits with greater information exchange about patients' underlying medical conditions may result in better adherence to indicated care, values affirmation holds promise as a means of improving outcomes of care for chronic ambulatory conditions in minority patients," suggest Edward Havranek (Denver Health Medical Center, Colorado, USA) and co-investigators.

The team randomly assigned 99 African-American individuals aged over 21 years who had hypertension to the intervention exercise, where they identified their self-defining personal values and skills, and described times when those values were important and why.

Participants in the control (sham) arm of the study completed a similar exercise but the focus was on values that were least important to them and in what situations they would have been important to someone else.

Audio recordings of patient-physician interactions revealed a significant number of utterances for the intervention and control group, at mean of 555 and 544, respectively.

Patients in the intervention group gave and asked for significantly more information about their medical condition than control patients, at 66.3 versus 48.1 utterances. However, there was no between-group difference in the exchange of information regarding therapy.

Furthermore, patients in the intervention group rated significantly higher for what Havranek and colleagues term the "positive tone", including interest, attentiveness, and friendliness, than their control-group counterparts, at 5.1 versus 4.8. Conversely, "negative tone" responses were significantly lower in the intervention group than the control group, at 1.1 versus 1.5.

The intervention did not significantly improve patient-reported trust in their physician or visit satisfaction, but neither did it increase stress.

"One potential cause of impaired communication in race-discordant patient-provider visits is termed stereotype threat, which occurs when members of certain groups fear being judged negatively according to stereotypes," explain the researchers.

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