The Relationship of Race/Ethnicity Concordance to Physician-Patient Communication: A Mixed-Methods Systematic Review

ABSTRACT

The concept of race or ethnic concordance between health care provider and patient has emerged as a dimension of the patient-physician relationship that could influence health outcomes for patients from minoritized groups, particularly through differences in the way physicians communicate with patients based on race or ethnicity. However, two decades of study on concordance and physician-patient communication have produced contradictory results. Given the heightened societal awareness of racism and the persistence of health disparities, there is a need for a comprehensive review of the current state of knowledge. This review sets out to determine how communication patterns differ in race/ethnicity concordant versus discordant patient-physician medical encounters. Thirty-three studies employing a range of methodologies were identified. In most analyses, after accounting for covariates, no relationship was found between race/ethnicity concordance and communication variables. Race/ethnicity concordance with their physician does not appear to influence the quality of communication for most patients from minoritized groups. A number of methodological weaknesses were identified in existing research, among them: few studies investigated potential explanatory variables, the heterogeneity of ethnic and cultural experience was over-simplified, there was little consistency in operationalization of communication variables, and the physician-patient dynamic was inadequately conceptualized.

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Notes

1. The driving motivation behind studies of physician-patient race/ethnicity concordance has been concern for the experiences of patients from minoritized groups. Therefore, Table 4 presents separate analyses of the experiences of non-White patients, as well as findings of analyses across racial/ethnic groups. It does not present results of separate analyses of White patients. Those are as follows. Out of 12 analyses of White patients’ experiences in race/ethnicity concordant versus discordant interactions, 5 found no effects. Five found a benefit to racial concordance (affective communication = 2; information exchange = 1; global communication = 2). Two found Black physician use of non-verbal behaviors was more positive toward White patients than other groups.

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Funding

The author(s) reported that there is no funding associated with the work featured in this article.