Do Patient-Provider Therapeutic Connections Vary by Race or Ethnicity? A Comparison of Black, White, and Hispanic/Latino Patient Experiences.

Abstract

Goal: This study aimed to determine whether patients who identify as Black/African-American or Hispanic/Latino have different expectations for and experiences of therapeutic connections (TCs) with care providers, compared to those who identify as non-Hispanic White. Although race-based health disparities have been recognized in the United States for decades, efforts to reduce them have yielded inconsistent results. Early evidence suggests that high-quality TCs have important impacts on patient outcomes, which could help explain the persistence of certain disparities.

Methods: Primary data were collected during a field study that recruited patients from across the U.S. (N = 1,598). We used a cross-sectional online survey of non-Hispanic Black, non-Hispanic White, and Hispanic or Latino (any race) adults who had a healthcare encounter in the previous six months. The sampling strategy oversampled Black and Hispanic/Latino patients and balanced respondents across age groups. The survey asked respondents questions about their expectations for ideal TCs, TC experiences, and satisfaction with their main care provider. Our large sample enabled subgroup analyses that examined the experiences of those with certain intersectional identities (e.g., race and gender). Variables were examined using omnibus analysis of variance with Fisher's least significant difference post hoc tests to compare specific groups.

Principal findings: There were no differences between groups regarding their expectations for ideal TCs. There were, however, differences by race/ethnicity in TC experiences and satisfaction. Differences were more prevalent in subgroup analyses. Chronic conditions, gender, and racial concordance with the provider mattered for some measures but not for others. Generally, Hispanic or Latino patients reported significantly lower levels of experienced TCs.

Practical applications: Understanding the differences in experiences of care and patient satisfaction by race/ethnicity can facilitate the cultivation of targeted interventions and policies aimed at addressing disparities in healthcare delivery and further promote equitable care for all patients. Nevertheless, more must be done to understand what might lead to poorer TCs for some who identify with marginalized groups and whether poorer TCs lead to poorer health outcomes.