December 17, 2020

Modified nonverbal communication from doctors may reduce disparities in Black cancer patient outcomes

A team led by Wayne State University Assistant Professor of Oncology Lauren Hamel, Ph.D., has identified discernable patterns of behaviors between Black patients with cancer and their oncologists.

Identifying behavioral patterns in clinical interactions with Black patients and their oncologists is particularly important as researchers like Dr. Hamel and her team at the Barbara Ann Karmanos Cancer Institute seek to find modifiable behaviors that may contribute to reduced disparities in communication, and ultimately, in treatment and mortality.

The team measured discrete behaviors like smiling, eye gaze and leaning in that could potentially be modified to help physicians connect with their patients, and especially Black patients.

“Our findings in this context of clinical communication between Black patients and their physicians suggest convergence is most likely to occur if the physician converges with the patient. Physicians could use this information to identify moments in their interactions with Black patients to converge behaviorally as a way to improve communication. For example, if a patient leans in or looks to meet the physician’s gaze, the physician could interpret those behaviors as positive, and behave similarly,” she said.

“Examining the Dynamic Nature of Nonverbal Communication Between Black Patients with Cancer and Their Oncologists,” and an accompanying editorial, “Putting Nonverbal Communication Under a Lens: An Examination of the Dynamic Interplay of Patient-Provider Interactions Between Black Patients and Non-Black Physicians” were published Dec. 8 in Cancer, the journal of the American Cancer Society.

“As another example of a potentially important behavioral pattern, the regulatory sub-system we identified could also provide ways to improve clinical communication and contribute to reduced racial disparities in clinical communication,” she said.

When physicians interrupt patients, patients begin talking more, potentially in an attempt to gain control of the discussion. Physicians, in response, move their gaze to patients as patients speak. Conversely, findings showed that when patients are talking, physicians interrupt and move their gaze away.

The editorial contextualizes the problem they are investigating, and advises on where to go next, both as a field of study and as a health care system.

“If physicians become aware of both their own and their patients’ interrupting behaviors, they may be able to facilitate a more productive conversation with their Black patients,” Dr. Hamel said. “Despite a desire to provide more information, perhaps it would be advantageous to allow patients more time to speak before taking their conversational turn. Thus, behavioral convergence and divergence contribute to our understanding by suggesting that physicians engage in certain behaviors such as smiling and leaning in to facilitate convergence with their Black patients, or breaking up their talk time and reducing their interruptions while patients are speaking as a way to avoid divergence with their Black patients.”

Dr. Hamel has studied nonverbal communication in various contexts since working on her master’s degree.

“Nonverbal communication is critical in the context of clinical communication, especially as we think about how disparities in clinical communication may contribute to disparities in treatment and mortality,” she said. “Nonverbal communication channels are how the majority of emotion and relational information is transmitted between people. If you think about the differences in the relative richness of speaking to someone face to face compared to texting someone, an awful lot of information gets transmitted through nonverbal cues like facial expressions, tone of voice, posture and more.”

The study applies a statistically innovative method called thin slice methodology to examine nonverbal communication between Black patients with cancer and their oncologists. Thin slice methodology, an effective way to study clinical communication in particular, takes small segments of interactions and codes those rather than entire interactions.

Interactions of 74 patients and 15 medical oncologists were recorded between 2012 and 2014 in two cancer hospitals in Detroit.

Dr. Hamel recently completed a National Institutes of Health-funded grant that is assessing nonverbal synchrony, or the nonconscious coordination of physical movements, another type of nonverbal communication that has been shown to be important in clinical communication.

“We are the first to assess nonverbal synchrony and compare it in interactions with Black patients and White patients. Our findings from this study will shed more light into this problem and provide more evidence into interventions that we can implement to improve disparities in communication and care,” she said.

 The study was funded by the National Institute of Cancer (R03CA195147).

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