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Published in: Journal of General Internal Medicine 4/2009

01-04-2009 | Original Article

Physician Cultural Competence and Patient Ratings of the Patient-Physician Relationship

Authors: Kathryn A. Paez, PhD, MBA, RN, Jerilyn K. Allen, ScD, RN, FAAN, Mary Catherine Beach, MD, MPH, Kathryn A. Carson, ScM, Lisa A. Cooper, MD, MPH

Published in: Journal of General Internal Medicine | Issue 4/2009

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ABSTRACT

OBJECTIVE

To determine the association of patients’ ratings of the patient-physician relationship with physicians’ self-reported cultural competence (CC).

METHODS

Physicians completed a survey assessing their CC in three domains: motivation to learn about other cultures (motivation attitudes), awareness of white privilege and acceptance of a racial group’s choice to retain distinct customs and values (power assimilation attitudes), and clinical behaviors reflective of CC. Their African-American and white patients completed interviews assessing satisfaction with the medical visit, trust in their physician, perceptions of their physician’s respect for them and their participation in care. We conducted regression analyses to explore the associations between CC and patient ratings of the relationship.

RESULTS

Patients of physicians reporting more motivation to learn about other cultures were more satisfied (OR = 2.1, 95% CI = 1.0–4.4), perceived their physicians were more facilitative (β = 0.4, p = 0.02) and reported seeking and sharing more information during the medical visit (β = 0.2, p = 0.03). Physicians’ power assimilation attitudes were associated with patients’ ratings of physician facilitation (β = 0.4, p = 0.02). Patients of physicians reporting more frequent CC behaviors were more satisfied (OR = 3.1, 95% CI = 1.4–6.9) and reported seeking and sharing more information (β = 0.3, p = 0.04).

CONCLUSIONS

Attitudinal and behavioral components of CC are important to developing higher quality, participative relationships between patients and their physicians.
Literature
1.
go back to reference Johnson RL, Saha S, Arbelaez JJ, Beach MC, Cooper LA. Racial and ethnic differences in patient perceptions of bias and cultural competence in health care. J Gen Intern Med. 2004;19:101–10.PubMedCrossRef Johnson RL, Saha S, Arbelaez JJ, Beach MC, Cooper LA. Racial and ethnic differences in patient perceptions of bias and cultural competence in health care. J Gen Intern Med. 2004;19:101–10.PubMedCrossRef
2.
go back to reference Cooper LA, Beach MC, Johnson RL, Inui TS. Delving below the surface. Understanding how race and ethnicity influence relationships in health care. J Gen Intern Med. 2006;21:S21–7.PubMedCrossRef Cooper LA, Beach MC, Johnson RL, Inui TS. Delving below the surface. Understanding how race and ethnicity influence relationships in health care. J Gen Intern Med. 2006;21:S21–7.PubMedCrossRef
3.
go back to reference Taira DA, Safran DG, Seto TB,et al. Do patient assessments of primary care differ by patient ethnicity? Health Serv Res. 2001;36:1059–71.PubMed Taira DA, Safran DG, Seto TB,et al. Do patient assessments of primary care differ by patient ethnicity? Health Serv Res. 2001;36:1059–71.PubMed
4.
go back to reference Doescher MP, Saver BG, Franks P, Fiscella K. Racial and ethnic disparities in perceptions of physician style and trust. Arch Fam Med. 2000;9:1156–63.PubMedCrossRef Doescher MP, Saver BG, Franks P, Fiscella K. Racial and ethnic disparities in perceptions of physician style and trust. Arch Fam Med. 2000;9:1156–63.PubMedCrossRef
5.
go back to reference Collins KS, Hughes DL, Doty MM, Ives BL, Edwards JN, Tenney K. Diverse Communities, Common Concerns: Assessing Health Care Quality for Minority Americans. The Commonwealth Fund. 2002. Collins KS, Hughes DL, Doty MM, Ives BL, Edwards JN, Tenney K. Diverse Communities, Common Concerns: Assessing Health Care Quality for Minority Americans. The Commonwealth Fund. 2002.
6.
go back to reference Cooper-Patrick L, Gallo JJ, Gonzales JJ,et al. Race, gender, and partnership in the patient-physician relationship. JAMA. 1999;282:583–9.PubMedCrossRef Cooper-Patrick L, Gallo JJ, Gonzales JJ,et al. Race, gender, and partnership in the patient-physician relationship. JAMA. 1999;282:583–9.PubMedCrossRef
7.
go back to reference Crow R, Gage H, Hampson S, et al. The measurement of satisfaction with healthcare: Implications for practice from a systematic review of the literature. Health Technol Assess. 2002;6. Crow R, Gage H, Hampson S, et al. The measurement of satisfaction with healthcare: Implications for practice from a systematic review of the literature. Health Technol Assess. 2002;6.
8.
go back to reference Safran DG, Taira DA, Rogers WH, Kosinski M, Ware JE, Tarlov AR. Linking primary care performance to outcomes of care. J Fam Pract. 1998;47:213–20.PubMed Safran DG, Taira DA, Rogers WH, Kosinski M, Ware JE, Tarlov AR. Linking primary care performance to outcomes of care. J Fam Pract. 1998;47:213–20.PubMed
9.
go back to reference Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. Washington, DC: National Academies Press;2003. Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. Washington, DC: National Academies Press;2003.
10.
go back to reference Cooper LA, Roter DL. Patient-provider communication: The effect of race and ethnicity on process and outcomes. In: Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. Washington, DC: National Academies Press; 2003. Cooper LA, Roter DL. Patient-provider communication: The effect of race and ethnicity on process and outcomes. In: Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. Washington, DC: National Academies Press; 2003.
11.
go back to reference Cooper LA, Roter DL, Bone LR, Larson SM, Miller ER, Barr MS, Carson KA, Levine DM. A randomized controlled trial of interventions to enhance patient-physician partnership, patient adherence and high blood pressure control among ethnic minorities and poor persons: Study Protocol NCT00123045. Implement Sci. 2009; in press. Cooper LA, Roter DL, Bone LR, Larson SM, Miller ER, Barr MS, Carson KA, Levine DM. A randomized controlled trial of interventions to enhance patient-physician partnership, patient adherence and high blood pressure control among ethnic minorities and poor persons: Study Protocol NCT00123045. Implement Sci. 2009; in press.
12.
go back to reference Paez KA, Allen JK, Carson KA, Cooper LA. Provider and clinic cultural competence in a primary care setting. Soc Sci Med. 2008;66:1204–16.PubMedCrossRef Paez KA, Allen JK, Carson KA, Cooper LA. Provider and clinic cultural competence in a primary care setting. Soc Sci Med. 2008;66:1204–16.PubMedCrossRef
13.
go back to reference Stewart AL, Napoles-Springer A, Perez-Stable EJ. Interpersonal processes of care in diverse populations. Milbank Q. 1999;77:305, 39, 274.PubMedCrossRef Stewart AL, Napoles-Springer A, Perez-Stable EJ. Interpersonal processes of care in diverse populations. Milbank Q. 1999;77:305, 39, 274.PubMedCrossRef
14.
go back to reference Kao AC, Green DC, Zaslavsky AM, Koplan JP, Cleary PD. The relationship between method of physician payment and patient trust. JAMA. 1998;280:1708–14.PubMedCrossRef Kao AC, Green DC, Zaslavsky AM, Koplan JP, Cleary PD. The relationship between method of physician payment and patient trust. JAMA. 1998;280:1708–14.PubMedCrossRef
15.
go back to reference Anderson LA, Dedrick RF. Development of the trust in physician scale: A measure to assess interpersonal trust in patient-physician relationships. Psychol Rep. 1990;67:1091–100.PubMed Anderson LA, Dedrick RF. Development of the trust in physician scale: A measure to assess interpersonal trust in patient-physician relationships. Psychol Rep. 1990;67:1091–100.PubMed
16.
go back to reference Lerman CE, Brody DS, Caputo GC, Smith DG, Lazaro CG, Wolfson HG. Patients' perceived involvement in care scale: Relationship to attitudes about illness and medical care. J Gen Intern Med. 1990;5:29–33.PubMedCrossRef Lerman CE, Brody DS, Caputo GC, Smith DG, Lazaro CG, Wolfson HG. Patients' perceived involvement in care scale: Relationship to attitudes about illness and medical care. J Gen Intern Med. 1990;5:29–33.PubMedCrossRef
17.
go back to reference Wade P, Bernstein BL. Cultural sensitivity training and counselor's race: Effects on black female clients perceptions and attrition. J Counseling Psych. 1991;38:9–15.CrossRef Wade P, Bernstein BL. Cultural sensitivity training and counselor's race: Effects on black female clients perceptions and attrition. J Counseling Psych. 1991;38:9–15.CrossRef
18.
go back to reference Fernandez A, Schillinger D, Grumbach K,et al. Physician language ability and cultural competence. An exploratory study of communication with Spanish-speaking patients. J Gen Intern Med. 2004;19:167–74.PubMedCrossRef Fernandez A, Schillinger D, Grumbach K,et al. Physician language ability and cultural competence. An exploratory study of communication with Spanish-speaking patients. J Gen Intern Med. 2004;19:167–74.PubMedCrossRef
19.
go back to reference Thom DH, Tirado MD. Development and validation of a patient-reported measure of physician cultural competency. Med Care Res Rev. 2006;63:636–55.PubMedCrossRef Thom DH, Tirado MD. Development and validation of a patient-reported measure of physician cultural competency. Med Care Res Rev. 2006;63:636–55.PubMedCrossRef
20.
go back to reference Gozu A, Beach MC, Price EG,et al. Self-administered instruments to measure cultural competence of health professionals: A systematic review. Teach Learn Med. 2007;19:180–90.PubMed Gozu A, Beach MC, Price EG,et al. Self-administered instruments to measure cultural competence of health professionals: A systematic review. Teach Learn Med. 2007;19:180–90.PubMed
Metadata
Title
Physician Cultural Competence and Patient Ratings of the Patient-Physician Relationship
Authors
Kathryn A. Paez, PhD, MBA, RN
Jerilyn K. Allen, ScD, RN, FAAN
Mary Catherine Beach, MD, MPH
Kathryn A. Carson, ScM
Lisa A. Cooper, MD, MPH
Publication date
01-04-2009
Publisher
Springer-Verlag
Published in
Journal of General Internal Medicine / Issue 4/2009
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-009-0919-7

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