Examining the dynamic nature of nonverbal communication between Black patients with cancer and their oncologists

Abstract

Background Although communication quality is associated with patient outcomes, racial disparities in communication exist, disproportionately burdening Black patients. However, most communication research focuses on verbal behaviors in predominantly White patient populations. We used a newly developed and theory‐guided network analysis that examines the dynamic interplay and behavioral convergence and divergence between Black patients with cancer and their oncologists during cancer treatment discussions. Methods We applied a nonverbal behavioral coding system to thin slices of video recordings of Black patients and their oncologists discussing treatment. We then estimated 3 networks: 1) a temporal network to determine whether a nonverbal behavior predicts another nonverbal behavior at the next time point in an interaction, and how much each nonverbal behavior influences other nonverbal behaviors and is influenced by other nonverbal behaviors; 2) a contemporaneous network to determine whether a nonverbal behavior co‐occurs with other nonverbal behaviors at the same time point in an interaction; and 3) a between‐dyads network to examine the covariation between nonverbal behaviors across all dyads. Results Black patients (n = 74) and their non‐Black physicians (n = 15) showed a mix of convergence and divergence in their nonverbal behaviors at the same points in time, from one time point to the next, and across dyads. Across analyses, convergence was most likely to occur when physicians matched their behaviors to their patients; especially with smiling, gaze, leaning, and laughter behaviors. Conclusion Our findings reveal patterns of modifiable behaviors that can potentially inform interventions to reduce disparities in clinical communication and, in turn, treatment and mortality disparities.

Change Process in Coaching: Interplay of Nonverbal Synchrony, Working Alliance, Self-Regulation, and Goal Attainment

“…In a further explorative step, the temporal associations across coaching sessions were modeled, using a network approach (Epskamp, 2020 ; Jordan et al, 2020 ), which has recently been applied to various fields of psychology, such as clinical psychology (Lutz et al, 2018 ; Kaiser and Laireiter, 2019 ) or patient-physician interactions (Hamel et al, 2020 ). In this modeling approach, a phenomenon is seen as a network of specific elements (e.g., symptoms, factors) that dynamically interact and impact one another over time.…”

Nonverbal Synchrony: An Indicator of Clinical Communication Quality in Racially-Concordant and Racially-Discordant Oncology Interactions

“… 27 Our study team recently observed that in an oncology setting, patients and oncologists smile, orient themselves to 1 another, and lean in toward 1 another at similar rates of frequency, but oncologists are more likely than patients to display an open posture. 21 Oncologists tend to interrupt patients more than patients interrupt oncologists, and oncologists spend more time speaking compared to patients. We also see that patients exhibit continuer behaviors (eg, head nods) to a greater extent than oncologists.…”

What Do Placebo and Nocebo Effects Have to Do With Health Equity? The Hidden Toll of Nocebo Effects on Racial and Ethnic Minority Patients in Clinical Care

“…In a study examining racial disparities in communication, the results found that communication quality was improved when physicians’ behavior was matched to that of the patients. For example, physicians could focus on matching patient behaviors of smiling, gazing, and laughter as these behaviors have been shown to elicit a favorable response from patients ( Hamel et al, 2021 ). Studies have also shown that the implicit racial bias of physicians can be decreased significantly by completing the Black-White IAT during the first and last semester of medical school ( van Ryn et al, 2015 ).…”

“…Racial disparities in communication have been documented and are considered driving factors for poor treatment adherence and negative experiences in the health care setting ( Hamel et al, 2021 ). When recordings of clinic visits were assessed by independent raters, non-White patients were found to experience unfavorable treatment and suboptimal communication compared to their White counterparts.…”