The Impact of Racial/Ethnic Concordance in Patient-Reported Shared Decision-Making and Communication During the COVID-19 Era.

Abstract

Background: Patient-provider racial/ethnic concordance may mitigate disparities, which is likely due in part to improved communication. The COVID-19 pandemic exacerbated disparities and raised questions on communication, warranting further exploration to inform equitable care.

Objectives: This study aimed to investigate the influence of patient-provider racial/ethnic concordance on patient-reported shared decision-making and communication during the early stages of the pandemic.

Research design: Stepwise logit models were constructed of short-term non-modifiable factors (race/ethnicity, education, age, marital status), modifiable factors (health insurance, poverty status), and self-reported health status predicting communication outcomes-whether the provider included the patient in decision-making and communicated treatment options.

Subjects: Adults from the 2020 US Medical Expenditure Panel Survey (N=9634), weighted consistent with complex sampling.

Measures: Shared decision-making and communication of treatment options by the primary care provider were assessed by patient surveys. Demographic characteristics included race/ethnicity, poverty status, age, marital status, education, and insurance status.

Results: Concordance was associated with greater age and socioeconomic status, and being married, White, and in good health. Concordance was associated with patient-reported shared decision-making and communication of treatment options. The associations between demographic characteristics and communication outcomes differed significantly by concordance status, which further differed by race/ethnicity. For example, shared decision-making was predicted by education for discordant Hispanic patients and marital status for discordant White patients, but neither were predictive among concordant patients.

Conclusions: The findings suggest a potential association between concordance on shared decision-making and communication dynamics, emphasizing the need for additional research to clarify how similarities and differences may influence health care interactions.