Abstract

Background: Cancer is a disease of aging. According to the National Cancer Institute of the United States of America, about 39% of men and women will be diagnosed with some form of cancer during their lifetime. Advancing age is the greatest risk factor for cancer overall. Unfortunately, certain groups bear a disproportionate cancer burden. For example, racial/ethnic minority patients (e.g., Black Americans) are more likely to experience disparities in their cancer treatment and, as a result, are about 20% more likely to die from their cancer, compared to White patients. Poorer patient-physician communication with minority patients compared to White patients has been identified as a likely contributor to cancer treatment disparities, but the nonverbal behaviors/communication that contribute to this problem are largely unknown. We examined nonverbal synchrony, or the nonconscious coordination of movement, which can reflect relationship quality and predict interaction outcomes.

We hypothesized that 1) interactions with Black patients will have lower levels of nonverbal synchrony compared to similar interactions with White patients, and 2) greater nonverbal synchrony will be associated with greater observed patient-centered communication.

Methods: Data include video recordings of 68 Black patients and 163 White patients discussing cancer treatment with their non-Black oncologists. Recordings were submitted to motion detection software to measure nonverbal synchrony. This software measures global synchrony (all correlated motion), peak synchrony (all positively correlated motion), who is leading the interaction (similar to who is leading in ballroom dancing), and how much synchrony occurs based on who is leading the interaction.
Trained research assistants then observed each video and rated the physicians’ patient-centered communication using a validated 12-item scale with three subscales (e.g., informativeness, supportiveness, and partnership building). Using multi-level models, we investigated whether nonverbal synchrony differed in interactions with Black patients and interactions with White patients, and whether nonverbal synchrony influenced physicians’ patient-centered communication.

Results: Findings showed greater levels of global synchrony (p<.05) and greater peak synchrony (p<.05) in interactions with Black patients compared to interactions with White patients. Global synchrony was the same in interactions with White patients regardless of who was leading, but greater global synchrony occurred in interactions with Black patients when the patient was leading (p<.05).
Regarding physicians’ patient-centered communication, we found that mean lag (who is leading or following in the interaction) interacts with interaction type (Black patient vs. White patient) such that in the interactions with Black patients, the longer the patient took to respond to the physician's behavior, the less patient centered the physician’s communication was observed to be (p=.03). We found the same interaction for the partnership building subscale (p=.05). We did not find this relationship in interactions with White patients.

Conclusions: This is the first study to use a dynamic jointly determined measure of behavior to assess oncology interactions. Contrary to our hypothesis, nonverbal synchrony was greater in interactions with Black patients than in interactions with White patients. It appears Black patients are driving more of the synchrony in their interactions compared to White patients. We also found when Black patients are struggling to follow the physician (either behaviorally or logically) the observed physicians’ patient-centered communication/partnership building decreases. Taken together, these findings are suggesting that there is more to overcome in interactions with Black patients compared to White patients and, perhaps, Black patients are adapting to their physicians’ behavior to bridge racial differences. Findings could contribute to physician training to enhance coordination and outcomes in oncology interactions.