Effects of Patient-Provider Race Concordance and Smoking Status on Lung Cancer Risk Perception Accuracy Among African-Am
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ORIGINAL ARTICLE
Effects of Patient-Provider Race Concordance and Smoking Status on Lung Cancer Risk Perception Accuracy Among African-Americans Susan Persky, PhD & Kimberly A. Kaphingst, ScD & Vincent C. Allen Jr., MA & Ibrahim Senay, PhD Published online: 7 February 2013 # The Society of Behavioral Medicine (outside the USA) 2013
Abstract Background Communication of lung cancer risk information between providers and African-American patients occurs in a context marked by race-based health disparities. Purpose A controlled experiment assessed whether perceived physician race influenced African-American patients’ (n=127) risk perception accuracy following the provision of objective lung cancer risk information. Methods Participants interacted with a virtual reality-based, simulated physician who provided personalized cancer risk information. Results Participants who interacted with a racially discordant virtual doctor were less accurate in their risk perceptions at post-test than those who interacted with a concordant virtual doctor, F(1,94)=4.02, p=.048. This effect was amplified among current smokers. Effects were not mediated by trust in the provider, engagement with the health care system, or attention during the encounter. Conclusions The current study demonstrates that AfricanAmerican patients’ perceptions of a doctor’s race are sufficient to independently impact their processing of lung cancer risk information. Keywords Lung cancer . Risk perception . Race concordance . Smoking . Virtual reality S. Persky (*) Social and Behavioral Research Branch, National Human Genome Research Institute, 31 Center Drive, Rm. B1B36, Bethesda, MD 20892, USA e-mail: [email protected] K. A. Kaphingst Washington University in St. Louis, St. Louis, MO, USA V. C. Allen Jr. University of California, Los Angeles, Los Angeles, CA, USA I. Senay Zirve University, Gaziantep, Turkey
Disparities in cancer outcomes between African-Americans and Whites are well documented. African-Americans are more likely than Whites and several other racial and ethnic groups to be diagnosed with and die from lung cancer [1, 2]. Explanations for these disparities are posited to be multifaceted and complex [3]. They include social and environmental causes like socio-economic status and access to care [4], engagement with risk behaviors (e.g., higher rates of menthol cigarette smoking [5]), and, more recently, a growing recognition that genetic variation underpins components of disease risk [6]. Another important source of disparities in health outcomes is that African-American patients may have negative encounters in the health care system related to prejudice and discrimination [7], and experience less effective clinical communication with providers [8]. These factors create the context in which objective lung cancer risk information is communicated by providers and subjectively understood by patients. Indeed, perception of risk is a process whereby a multitude of factors, both internal and external to an individual, influence beliefs about disease ris
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