scholarly journals Socioeconomic, racial and ethnic differences in patient experience of clinician empathy: Results of a systematic review and meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0247259
Author(s):  
Brian W. Roberts ◽  
Nitin K. Puri ◽  
Christian J. Trzeciak ◽  
Anthony J. Mazzarelli ◽  
Stephen Trzeciak
Keyword(s):  
Health Care ◽  
Native American ◽  
Patient Experience ◽  
Health Care Disparities ◽  
Statistical Significance ◽  
Measure Data ◽  
Low Ses ◽  
Patient Reported ◽  
Race Ethnicity ◽  
Care Measure

Introduction Empathy is essential for high quality health care. Health care disparities may reflect a systemic lack of empathy for disadvantaged people; however, few data exist on disparities in patient experience of empathy during face-to-face health care encounters with individual clinicians. We systematically analyzed the literature to test if socioeconomic status (SES) and race/ethnicity disparities exist in patient-reported experience of clinician empathy. Methods Using a published protocol, we searched Ovid MEDLINE, PubMed, CINAHL, EMBASE, CENTRAL and PsychINFO for studies using the Consultation and Relational Empathy (CARE) Measure, which to date is the most commonly used and well-validated methodology for measuring clinician empathy from the patient perspective. We included studies containing CARE Measure data stratified by SES and/or race/ethnicity. We contacted authors to request stratified data, when necessary. We performed quantitative meta-analyses using random effects models to test for empathy differences by SES and race/ethnicity. Results Eighteen studies (n = 9,708 patients) were included. We found that, compared to patients whose SES was not low, low SES patients experienced lower empathy from clinicians (mean difference = -0.87 [95% confidence interval -1.72 to -0.02]). Compared to white patients, empathy scores were numerically lower for patients of multiple race/ethnicity groups (Black/African American, Asian, Native American, and all non-whites combined) but none of these differences reached statistical significance. Conclusion These data suggest an empathy gap may exist for patients with low SES. More research is needed to further test for SES and race/ethnicity disparities in clinician empathy and help promote health care equity. Trial registration Registration (PROSPERO): CRD42019142809.

scholarly journals Socioeconomic, racial and ethnic differences in patient experience of clinician empathy: Results of a systematic review and meta-analysis

2020 ◽  
Author(s):  
Brian W Roberts ◽  
Nitin K Puri ◽  
Christian J Trzeciak ◽  
Anthony J Mazzarelli ◽  
Stephen Trzeciak
Keyword(s):  
Health Care ◽  
Native American ◽  
Patient Experience ◽  
Health Care Disparities ◽  
Statistical Significance ◽  
Measure Data ◽  
Low Ses ◽  
Patient Reported ◽  
Race Ethnicity ◽  
Care Measure

Introduction: Empathy is essential for high quality health care. Health care disparities may reflect a systemic lack of empathy for disadvantaged people; however, few data exist on disparities in patient experience of empathy during face-to-face health care encounters with individual clinicians. We systematically analyzed the literature to test if socioeconomic status (SES) and race/ethnicity disparities exist in patient-reported experience of clinician empathy. Methods: Using a published protocol, we searched Ovid MEDLINE, PubMed, CINAHL, EMBASE, CENTRAL and PsychINFO for studies using the Consultation and Relational Empathy (CARE) Measure, which to date is the most commonly used and well-validated methodology for measuring clinician empathy from the patient perspective. We included studies containing CARE Measure data stratified by SES and/or race/ethnicity. We contacted authors to request stratified data, when necessary. We performed quantitative meta-analyses using random effects models to test for empathy differences by SES and race/ethnicity. Results: Eighteen studies (n=9,708 patients) were included. We found that, compared to patients whose SES was not low, low SES patients experienced lower empathy from clinicians (mean difference= -0.87 [95% confidence interval -1.72 to -0.02]). Compared to white patients, empathy scores were numerically lower for patients of multiple race/ethnicity groups (Black/African American, Asian, Native American, and all non-whites combined) but none of these differences reached statistical significance. Conclusion: These data suggest an empathy gap may exist for patients with low SES. More research is needed to further test for SES and race/ethnicity disparities in clinician empathy and help promote health care equity. Registration (PROSPERO): CRD42019142809

Patient-reported unfair treatment within the health care system.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 115-115
Author(s):  
Nicole E. Caston ◽  
Courtney Williams ◽  
Kathleen D. Gallagher ◽  
Rebekah Angove ◽  
Eric Anderson ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Categorical Variables ◽  
Medical Mistrust ◽  
Insurance Company ◽  
Medical Providers ◽  
Unfair Treatment ◽  
Patient Reported ◽  
Race Ethnicity ◽  
Care System

115 Background: Patients with cancer who perceive discrimination and unfair treatment from the health care system are at risk for lower health-related quality of life. This study seeks to better understand the characteristics of under-resourced patients who report unfair treatment from the health care system and providers. Methods: This cross-sectional analysis used data from a nationwide survey distributed in December 2020 by Patient Advocate Foundation (PAF), a US non-profit organization providing case management and financial aid to individuals with chronic illness. The survey was fielded via email to those who received PAF services from July 2019-April 2020. Inclusion criteria included a valid e-mail address, aged ≥ 19, and either current or previous cancer treatment. Respondents reported unfair treatment in connection to their health care. Age, sex, race/ethnicity, and annual household income were abstracted from the PAF database. The validated Group-Based Medical Mistrust Scale was used to assess respondents’ level of mistrust in medical providers as it relates to their ethnic group. Scores range from 12-60 and were categorized based on tertiles as high mistrust (scores ≥ 29), neutral (21-28), and low mistrust (≤ 20). Frequencies and percentages were calculated for categorical variables. Results: There were a total of 429 survey respondents with cancer. Most respondents were female (73%) and aged 56-75 (57%); 31% were Black, Indigenous, or Persons of Color (BIPOC). The most common cancer types were hematologic (33%) and breast (33%). Overall, 20% (n = 86) of respondents reported having received unfair treatment. Of those reporting unfair treatment, 56% reported receipt from their doctor, nurse, or health care provider, 51% insurance company, 38% the health care system, and 14% pharmacist. When asked why they felt unfairly treated, the most common responses were related to insurance status (51%), disease or condition (45%), and income (35%). Notably, unfair treatment due to race/ethnicity (6%), sex (9%), and sexual orientation/gender expression (3%) were uncommon. When compared to those who reported objective treatment, respondents reporting unfair treatment were more often unemployed/other (28% vs 11%), privately insured (38% vs 27%), having income < $23,000 (40% vs 25%), having 3+ comorbidities (40% vs 23%) and reporting more mistrust in medical providers (53% vs 27%). There did not appear to be a difference in reporting of unfair treatment by race/ethnicity. Of BIPOC respondents, 51% reported high mistrust in medical providers. Conclusions: This under-resourced population of respondents with cancer reported unfair treatment related to their finances, insurance, and disease status. Our data suggest health care-associated discrimination may occur based on socioeconomic resources. This work identifies a novel equity consideration warranting further evaluation.

scholarly journals Racial and socioeconomic disparities in patient experience of clinician empathy: a protocol for systematic review and meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e034247 ◽  
Author(s):  
Brian W Roberts ◽  
Christian J Trzeciak ◽  
Nitin K Puri ◽  
Anthony J Mazzarelli ◽  
Stephen Trzeciak
Keyword(s):  
Systematic Review ◽  
Patient Experience ◽  
Meta Analysis ◽  
Socioeconomic Disparities ◽  
Future Research ◽  
Individual Patient Level ◽  
Patient Reported ◽  
Original Manuscript ◽  
Methodological Guidelines ◽  
Care Measure

IntroductionClinician empathy is a vital component of high-quality healthcare. Healthcare disparities may reflect a societal lack of empathy for disadvantaged persons in general, and recent research suggests that socioeconomic disparities exist in patient satisfaction with clinicians. However, it is currently unclear if there are disparities in patient experience of empathy from clinicians. Our objective is to systematically analyse the scientific literature to test the hypothesis that racial and socioeconomic status (SES) disparities exist in patient-reported experience of clinician empathy.Methods and analysisIn accordance with published methodological guidelines for conducting a systematic review, we will analyse studies reporting patient assessment of clinician empathy using the Consultation and Relational Empathy (CARE) measure, which to date is the most commonly used and well-validated methodology in clinical research for measuring clinician empathy from the patient’s perspective. We will use a standardised data collection template and assess study quality (risk of bias) using the Newcastle-Ottawa Scale. We will abstract data for the CARE measure stratified by race and SES, and we will contact the corresponding authors to obtain stratified data by race/SES if not reported in the original manuscript. Where appropriate, we will pool the data and perform quantitative meta-analysis to test if non-white (compared to white) patients and low SES (compared to high SES) patients report lower scores for clinician empathy.Ethics and disseminationNo individual patient-level data will be collected and thus the proposed systematic review does not require ethical approval. This systematic review will test if racial and SES differences exist in patient experience of clinician empathy, and will inform future research to help promote healthcare equity.PROSPERO registration numberCRD42019142809.

scholarly journals Measuring the Patient Experience of Mental Health Care: A Systematic and Critical Review of Patient-Reported Experience Measures

2020 ◽  
Vol Volume 14 ◽  
pp. 2147-2161
Author(s):  
Sara Fernandes ◽  
Guillaume Fond ◽  
Xavier Y Zendjidjian ◽  
Karine Baumstarck ◽  
Christophe Lançon ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Patient Experience ◽  
Critical Review ◽  
Patient Reported

Self-reported patient experience and quality of care among elderly patients with colon cancer.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 33-33 ◽  
Author(s):  
Rebecca A Snyder ◽  
Rebecca Wardrop ◽  
Alexander Mclain ◽  
Alexander A. Parikh ◽  
Anna Cass
Keyword(s):  
Health Care ◽  
Patient Experience ◽  
Cancer Care ◽  
Health Care Quality ◽  
Care Quality ◽  
Stage I ◽  
Stage Iii ◽  
Experience Of Care ◽  
Patient Reported

33 Background: Although studies have identified demographic and clinical factors associated with quality colorectal cancer care, the association between patient-reported experience of care and quality of care is unknown. Our primary aim was to assess the relationship between patient-reported experience of care and receipt of guideline-concordant colon cancer (CC) treatment. Methods: Fee-For-Service Medicare beneficiaries with resected stage I-III CC (2003-2013) were identified in the linked SEER registry and Consumer Assessment of Healthcare Providers and Systems patient experience survey (SEER-CAHPS) dataset. Patient-reported ratings were compared based on receipt of care consistent with recommended treatment guidelines [resection of ≥ 12 lymph nodes (LN) (stage I-III) and receipt of adjuvant chemotherapy (stage III)]. Linear regression was performed to compare mean patient experience scores by receipt of guideline concordant care, adjusting for patient and hospital factors. Results: 1010 patients with stage I-III CC were identified (mean age 76.7, SE 6.9). Of these, 58.4% of stage I (n = 192/329) and 73.4% of stage II (n = 298/406) patients underwent resection of ≥ 12 LN. Among stage III patients, 76.0% (n = 209/275) underwent resection of ≥ 12 LN and 52.4% (n = 144/275) received adjuvant chemotherapy. By multivariable analysis, patient-reported ratings of health care quality, personal and specialty physicians, customer service, physician communication, getting needed care, and getting care quickly were similar among patients who received guideline-concordant treatment compared to those who did not. However, mean ratings of overall health care quality [91.3 (SE 2.0) vs. 82.4 (SE 1.7), p = 0.0004] and getting needed care [92.8 (SE 2.4) vs. 86.8 (SE 2.0), p = 0.047] were higher among stage III patients who received guideline concordant care compared to those who did not. Conclusions: Patient-reported ratings of health care quality and ability to get needed care are associated with guideline concordant cancer care among elderly patients with stage III CC. Further investigation is needed to determine if patient-reported experience correlates with other clinical measures of quality of colorectal cancer care.

scholarly journals The Systemic Exclusion of Native Americans from Cancer Clinical Trials.

2021 ◽  
Author(s):  
Joseph Angel De Soto ◽  
Gabriel Selassie ◽  
Gilberta Yazzie
Keyword(s):  
Health Care ◽  
Clinical Trials ◽  
Native American ◽  
African Americans ◽  
Native Americans ◽  
Ethnic Minorities ◽  
Health Care Disparities ◽  
The United States ◽  
Cancer Clinical Trials ◽  
Unnecessary Death

Introduction: A major source of health care disparities derives from the underrepresentation of ethnic minorities in clinical trials. The inclusion of ethnic minorities is necessary to generalize the results in terms of efficacy and toxicology of medications in cancer treatment. Methodology: In this retrospective study, 80 cancer clinical trials with an aggregate of 278,470 participants performed within the last ten years were selected at random. The number of ethnic minorities participating and inclusion of them in the results were evaluated. Results: Only, 42.5% of cancer clinical trials reported the ethnic background of participants in their trials while even less 5% reported the efficacy or toxicology of the therapeutic intervention for ethnic minorities. Whites, Hispanics, African Americans, and Native Americans make up 60.1%, 18.5%, 13.4% and 1.5% of the population they made up 85.3%, 2.54%, 7.6% and 0.12% of the participants that reported ethnicity, respectively. Out of 278,470 participants in cancer clinicals trials only 133 (0.048%) could be identified as Native American . Conclusion: Native Americans were nearly completely excluded from cancer clinical trials. African Americans and Hispanics were greatly underrepresented. Cancer Clinical trials may not be generalizable and have been inherently racist in the United States. This has led to the unnecessary death and suffering of Native Americans from cancer.

scholarly journals Review of patient-reported experience within Patient-Centered Medical Homes: insights for Australian Health Care Homes

2017 ◽  
Vol 23 (5) ◽  
pp. 429 ◽  
Author(s):  
Mary O'Loughlin ◽  
Jane Mills ◽  
Robyn McDermott ◽  
Linton Harriss
Keyword(s):  
Health Care ◽  
Patient Experience ◽  
Care Home ◽  
Health Service Delivery ◽  
The United States ◽  
Patient Centered ◽  
Australian Health ◽  
Qualitative Approaches ◽  
Patient Reported ◽  
Health Care Home

Understanding patient experience is necessary to advance the patient-centred approach to health service delivery. Australia’s primary healthcare model, the ‘Health Care Home’, is based on the ‘Patient-Centered Medical Home’ (PCMH) model developed in the United States. Both these models aim to improve patient experience; however, the majority of existing PCMH model evaluations have focussed on funding, management and quality assurance measures. This review investigated the scope of evidence reported by adult patients using a PCMH. Using a systematic framework, the review identified 39 studies, sourced from 33 individual datasets, which used both quantitative and qualitative approaches. Patient experience was reported for model attributes, including the patient–physician and patient–practice relationships; care-coordination; access to care; and, patient engagement, goal setting and shared decision-making. Results were mixed, with the patient experience improving under the PCMH model for some attributes, and some studies indicating no difference in patient experience following PCMH implementation. The scope and quality of existing evidence does not demonstrate improvement in adult patient experience when using the PCMH. Better measures to evaluate patient experience in the Australian Health Care Home model are required.

scholarly journals Systematic review: methodological flaws in racial/ethnic reporting for gastroesophageal reflux disease

2018 ◽  
Vol 31 (3) ◽  
Author(s):  
M R Craven ◽  
L Kia ◽  
L C O’Dwyer ◽  
E Stern ◽  
T H Taft ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Health Care Disparities ◽  
Related Factors ◽  
Majority Population ◽  
Race Ethnicity ◽  
Racial Ethnic

SUMMARY Health care disparities affecting the care of multiple disease groups are of growing concern internationally. Research guidelines, governmental institutions, and scientific journals have attempted to minimize disparities through policies regarding the collection and reporting of racial/ethnic data. One area where shortcomings remain is in gastroesophageal reflux disease (GERD). This systematic review, which adheres to the PRISMA statement, focuses on characterizing existing methodological weaknesses in research focusing on studies regarding the assessment, prevalence, treatment, and outcomes of GERD patients. Search terms included GERD and typical symptoms of GERD in ethnic groups or minorities. We reviewed 62 articles. The majority of studies did not report the race/ethnicity of all participants, and among those who did, very few followed accepted guidelines. While there were diverse participants, there was also diversity in the manner in which groups were labeled, making comparisons difficult. There appeared to be a disparity with respect to countries reporting race/ethnicity, with certain countries more likely to report this variable. Samples overwhelmingly consisted of the study country's majority population. The majority of studies justified the use of race/ethnicity as a study variable and investigated conceptually related factors such as socioeconomic status and environment. Yet, many studies wrote as if race/ethnicity reflected biological differences. Despite recommendations, it appears that GERD researchers around the world struggle with the appropriate and standard way to include, collect, report, and discuss race/ethnicity. Recommendations on ways to address these issues are included with the goal of preventing and identifying health care disparities.

Improving patient experience in health care and oncology: A scoping review.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 209-209
Author(s):  
Petra Grendarova ◽  
Demetra Hariklea Yannitsos ◽  
Marcus Vaska ◽  
Lisa Catherine Barbera
Keyword(s):  
Health Care ◽  
Patient Experience ◽  
English Language ◽  
Grey Literature ◽  
Systematic Change ◽  
Cross Sectional ◽  
Positive Effects ◽  
Patient Reported ◽  
Care Surgery ◽  
Improve Patient

209 Background: Patient-reported experience measures (PREMs) gather information directly from patients and capture their perspectives on their health care. Deficiencies identified by PREMs can lead to quality improvement (QI) interventions. The purpose of this review was to identify published and unpublished evidence on initiatives aimed to improve patient experience, to identify their areas of application and their overall impact on patient experience. Methods: We conducted a systematic literature review using MEDLINE (Ovid), EBM Reviews, HealthStar, PsycINFO, PubMed, PubMed Central, CINAHL, MEDLINE (Ebsco), Psychology & Behavioral Sciences, TRIP Database, EMBASE and Web of Science databases and several sources of grey literature. Inclusion criteria required the studies to evaluate an intervention or a systematic change aimed to improve patient experience and measured by a specific PREM. The search was limited to English language reports published between 1998 and 2018. Of the initial 780 articles, 318 were included in abstract reviews. 304 abstracts were excluded leaving 44 records for full text review. Results: 21 records were included in the final analysis (20 journal articles and 1 web report). Publication dates ranged between 2007 and 2018 in the USA, UK, Norway, Denmark, Belgium and Bangladesh. There were 8 QI initiatives, 6 randomized studies, 1 non-randomized trial, 3 mixed methods, 2 repeated cross-sectional studies and 1 national patient experience model. Areas of focus included hospital care, surgery, internal medicine, primary care and oncology. Nine studies had programmatic interventions and 12 had specific interventions. All specific interventions reported positive effects. Outcomes were variable in programmatic interventions, including 5 studies reporting positive effects, 3 neutral and 1 mixed effects. Conclusions: The effect of specific interventions aimed to improve patient experience is positive. There is limited data on the effect of programmatic initiatives and the factors that drive the improvement in patient experience. Such initiatives are needed to understand their impact on patient experience and person-centered care.

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