Putting nonverbal communication under a lens: An examination of the dynamic interplay of patient–provider interactions between Black patients and non‐Black physicians

Discordant and ineffective communication between patients and providers are critical factors contributing to the health care disparities observed among Black patients. Shorter visit times, less rapport-building behaviors and statements, and lower participatory decision making are unfortunate characteristics of patient–physician interactions for Black patients in racially discordant pairs. A study by Cooper et al demonstrated that Black patients in racially discordant physician encounters experienced shorter visit times and generally rated their physicians as less participatory compared with concordant pairings. Similarly, Cene et al reported that visit lengths were shorter among Black patients seeking care for their hypertension and that patient race had a larger impact on the communication quality of their physician than patient blood pressure control. These ineffective communication pairings widen the disparate gaps in the care of Black patients and negatively influence their outcomes. It has been reported that Black patients experience poorer quality communication marked by decreased participatory decision making, information giving, and patient participation compared with their White counterparts. Moreover, there is no robust literature indicating that white patients receive lower quality care or perceive worse communicative interaction in discordant patient–physician dyads compared with Black patients. A clear link between patient-centered communication and patient trust in their physician has been made in the literature. As a result, it has been suggested that these poor-quality interactions contribute to the lower post-visit trust in physicians that Black patients report. In a study comparing preand post-visit patient-reported trust in physicians, Gordon et al found similar expectations between Black and White patients prior to their visit. However, trust in physicians significantly decreased for Black patients after their visits, as they reported their racially discordant physicians’ communication was less informative, less partnering, and less supportive. Overtly or implicitly held race-related attitudes among physicians contribute to differences in information exchange and ultimately treatment recommendations between Black and White patients, especially with regard to cancer treatment and pain management. Thus, the seemingly modifiable nature of patient–provider communication, and particularly provider-related communication techniques, make them an attractive focus for research and ultimately intervention in the realm of health care inequalities. Thus, it is with keen interest that we read the important work pertaining to patient–provider communication reported by Hamel et al in this issue of Cancer. The authors document and categorize the nonverbal interactions of Black patients with breast, colorectal, or lung cancer and their non-Black oncologists during treatment discussions. In turn, they offer insight and a framework in which to operationalize nonverbal cues and behaviors exhibited in racially discordant patient–provider interactions, and they assert that their findings may be used to improve communication quality. The authors succeed in pinpointing nonverbal behaviors that promote convergence and divergence between Black patients and their non-Black oncologists from one time point to the next. Moreover, they demonstrate that nonverbal behaviors such as physician gaze, physician laughter, and physician smile, which show convergence, promote desired similarity between the patient and provider as well as mutual closeness. While the focus of prior studies has been on coding nonverbal patient and provider behaviors and correlating them with patient-reported satisfaction and communication, Hamel et al document the strength of these behaviors on subsequent nonverbal behaviors. With this, the authors highlight the importance of understanding the dynamic interplay that is implicit in any communicative exchange, which is unaddressed in other studies.