Assessment of Black Patients’ Perception of Their Dermatology Care

Abstract

IMPORTANCE The availability and quality of skin and hair care for black patients in the United States has been a subject of growing interest in dermatology. There is limited understanding of the perceptions of black patients about the care they receive from dermatologists and the factors affecting their care satisfaction. OBJECTIVE To elucidate black patients' perceptions of their dermatology experience in and outside of a skin of color clinic (SOCC). DESIGN, SETTING, AND PARTICIPANTS A cross-sectional study involving a survey and focus groups was conducted including adult black patients treated in an SOCC. Recruitment was conducted April through June 2015 through clinic-posted flyers. Participants engaged in 1 of 4 focus groups on July 14, 15, 29, or 30, 2015, and completed a survey. Data were analyzed March 2016 through June 2017. MAIN OUTCOMES AND MEASURES Planned outcomes of the focus groups were black patients' inductively generated themes on their perspectives and experiences in dermatology clinics. Planned outcomes of the survey were patients' ratings of SOCC and non-SOCC dermatologists in terms of interaction style, cultural awareness, and treatment satisfaction. Importance of patient-dermatologist racial concordance was a planned outcome in both measures. Given lack of existing prior research, no specific hypotheses were generated. RESULTS Of the 19 adult black patients who participated in the study, 18 (95%) were women, and the mean (SD) age was 50.0 (14.2) years. All patients reported positive experiences in the SOCC. Compared with non-SOCC dermatology treatment experiences, patients reported higher levels of overall satisfaction with SOCC dermatologists (t 13 = 2.85; P = .01). Patients perceived that SOCC dermatologists were better trained to care for black patients (t 13 = 4.42; P = .001); showed patients greater respect and dignity (t 13 = 3.37; P = .005), as well as understanding (t 13 = 2.56, P = .02); and were more trustworthy (t 13 = 3.47; P = .004). The majority of the comments in the focus groups (n = 207) described 2 themes: dermatologists' interaction style (62/207; 30.0%) and knowledge about black skin and hair (42/207; 20.3%). Other themes were partnering with patients on outcomes (17/207; 8.2%), shared life experiences (14/207; 6.8%), and economic sensitivity (7/207; 3.4%). These themes accounted for a large part of the participants' discussion. Of all respondents, 71% (12/17) stated that they would prefer a black (or race concordant) dermatologist; this included 91% (10/11) of the race-concordant group and 33% (2/6) of the race-discordant group. CONCLUSIONS AND RELEVANCE Participants reported that the SOCC dermatologists provided unique and uniformly beneficial care to black patients. Care satisfaction appeared most related to dermatologists' interpersonal style and specialized knowledge in care of black skin and hair. Findings suggest that black patients' dermatologic care satisfaction would increase if dermatologists underwent enhanced residency training in skin of color, cultural comp...

Sunscreen recommendations for patients with skin of color in the popular press and in the dermatology clinic

“…This survey statistic is one specific example of the increasingly recognized need for residency training and ongoing learning after graduation to serve the unique needs of patients with darker skin tones, as well as increased representation of dermatology practitioners with skin of color ( Imadojemu and James, 2016 , Pandya et al, 2016 , Taylor, 2019 ). Patient satisfaction with care during dermatology visits is highly tied to specialized knowledge of black skin and hair, and cursory recommendations to use a physical sunscreen without further discussion of possible associated challenges could make patients feel that providers are unaware of and/or unable to provide individualized treatment recommendations for darker skin ( Gorbatenko-Roth et al, 2019 , Taylor, 2019 ). These factors may explain patient preference for race-concordant visits in dermatology, which has also been demonstrated in other specialties ( Cooper et al, 2003 , Gorbatenko-Roth et al, 2019 , LaVeist and Nuru-Jeter, 2002 ).…”

“…Patient satisfaction with care during dermatology visits is highly tied to specialized knowledge of black skin and hair, and cursory recommendations to use a physical sunscreen without further discussion of possible associated challenges could make patients feel that providers are unaware of and/or unable to provide individualized treatment recommendations for darker skin ( Gorbatenko-Roth et al, 2019 , Taylor, 2019 ). These factors may explain patient preference for race-concordant visits in dermatology, which has also been demonstrated in other specialties ( Cooper et al, 2003 , Gorbatenko-Roth et al, 2019 , LaVeist and Nuru-Jeter, 2002 ).…”

Disparities in the Utilization of Dermatologists for Primary Cicatricial Alopecias

“…We could not, however, assess the impact of race-discordance on these results given the previous lack of diversity within our department, and dermatology in general-the second least diverse specialty of black patients prefer to see a black (or race-concordant) dermatologist, and that black men are more likely to consent to influenza vaccinations and cardiovascular disease screenings from physicians who are black than from physicians who are white. 3,4 Our findings further emphasize the need for increasing racial diversity within the dermatology workforce and even more importantly, ensuring all trainees receive adequate training, both of which will potentially increase utilization of dermatologists for scarring alopecias. Additionally, educational campaigns highlighting the importance of early dermatologic interventions in cicatricial alopecias-targeting the affected patient populations and referring physicians-may prompt patients to obtain treatment earlier in the disease course.…”

Bridging racial differences in the clinical encounter: How implicit bias and stereotype threat contribute to health care disparities in the dermatology clinic

“…Studies show that many Black patients find that race-discordant dermatology visits (provider of another race) often lack specific knowledge of Black patients’ skin, hair, and hair care regimens and that these dermatologists fail to offer individualized treatments for their disorders, with >70% of Black patients preferring a Black dermatologist ( Gorbatenko-Roth et al, 2019 , Taylor, 2019 ). Black patients perceive dermatologists at Skin of Color Centers as more trustworthy, better trained to care for them, and more likely to exhibit greater respect toward them and afford them greater dignity ( Gorbatenko-Roth et al, 2019 ).…”

“…Studies show that many Black patients find that race-discordant dermatology visits (provider of another race) often lack specific knowledge of Black patients’ skin, hair, and hair care regimens and that these dermatologists fail to offer individualized treatments for their disorders, with >70% of Black patients preferring a Black dermatologist ( Gorbatenko-Roth et al, 2019 , Taylor, 2019 ). Black patients perceive dermatologists at Skin of Color Centers as more trustworthy, better trained to care for them, and more likely to exhibit greater respect toward them and afford them greater dignity ( Gorbatenko-Roth et al, 2019 ). With Black and Hispanic dermatologists making up only 3% and 4%, respectively, of the total number of dermatologists in the United States, this race-concordant preference does not meet the demand of the ethnic minorities who make up 12.8% and 16.3%, respectively, of the population ( Pandya et al, 2016 ).…”