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The effect of race on the referral process for invasive cardiac procedures
1Georgetown University Medical Center, USA.
Insights
Racial disparities impact cardiac care access for Black patients, affecting physician-patient communication and therapeutic partnerships. Addressing these requires further research and cultural competency in medical education.
Area of Science:
- Cardiology
- Health Disparities
- Medical Communication
Background:
- Coronary artery disease (CAD) is a leading cause of death in the US.
- Blacks experience higher rates of premature CAD and poorer outcomes post-myocardial infarction compared to whites.
- Existing research indicates Black patients are less likely to be referred for invasive cardiac procedures.
Purpose of the Study:
- To examine the effect of patient and physician race on decision-making processes for cardiac procedure referrals.
- To present a framework detailing the steps involved in accessing invasive cardiac care.
- To highlight the role of race in physician-patient communication and therapeutic alliance formation.
Main Methods:
- The study proposes a conceptual framework to analyze the multi-step referral process for invasive cardiac procedures.
- It examines how patient race can influence each stage of this process.
- The authors specifically consider the impact of race concordance/discordance between physicians and patients.
Main Results:
- Patient race can influence multiple steps in the pathway to invasive cardiac care.
- Race-discordant physician-patient relationships may impede effective communication regarding symptoms and preferences.
- Differences in race can hinder the establishment of a strong therapeutic partnership.
Conclusions:
- Communication plays a critical role in race-discordant physician-patient relationships concerning cardiac care.
- Further research is needed to understand physician decision-making in referral processes.
- Promoting cultural competency in medical education is essential to address racial disparities in cardiovascular care.
Abstract:
Coronary artery disease is the leading cause of death in the United States. Blacks are more likely than whites to experience premature disease, and they have poorer prognosis after acute myocardial infarction. Multiple studies have demonstrated that blacks are less likely to be referred for certain invasive cardiac procedures. Few studies have examined the effect of race on physician and patient decision making in referrals for cardiac procedures. The authors present a framework for the complex series of steps involved in obtaining invasive cardiac care. Patient race can affect each of these steps, and differences in physician and patient race may be a particular impediment to effective communication about symptoms and preferences and to the establishment of a therapeutic partnership. The potential role of communication in race-discordant physician-patient relationships suggests a need for more research in physician decision making and for efforts to promote cultural competency as a core component of medical education.