Eye patients’ perception of clinician respect varies by race, ethnicity
Patients with vision-threatening eye diseases who belong to a racial or ethnic minority group reported feeling less respected by clinicians than their non-Hispanic white counterparts, according to a cross-sectional cohort study.
“Among participants with vision-threatening eye disease, it is currently not understood if individuals in racial and ethnic minority groups feel they are treated with respect by their clinicians and if they feel they are asked about their opinions/beliefs for medical care,” Patrice M. Hicks, PhD, MPH, a postdoctoral research fellow in the department of ophthalmology and visual sciences at the University of Michigan in Ann Arbor, and colleagues wrote in JAMA Ophthalmology. “By determining if there is an association between racial and ethnic minority status and being treated with respect and being asked about opinion/beliefs of medical care, interventions can be developed to address health disparities in eye health and vision care.”
Hicks and colleagues drew data from the National Health Interview Survey (NHIS), which polled a nationally representative population of noninstitutionalized adults in the U.S. The 2017 NHIS included data on eye diseases, so 5,343 adults from that year’s cohort who self-reported age-related macular degeneration, diabetic retinopathy, glaucoma and cataracts were included for analysis.
The researchers stratified demographic characteristics with whether participants reported “always” feeling respected by clinicians or were “always” asked about their beliefs and opinions. Demographics included gender (male or female), age, education, race and ethnicity; people reporting race and ethnicity other than non-Hispanic white were categorized as belonging to a racial and ethnic minority group.
The study population consisted of 349 Hispanic people and 824 people identifying as Black, Asian or multiple/other races, comprising 21.11% of the cohort. Nearly half of all participants had a high school education or less (46%), and 98.34% of the population were aged 40 years or older. The most common eye disease was cataracts, seen in 89% of participants.
Adjusted multivariable modeling showed participants in a racial and ethnic minority group were less likely to report that their clinicians “always” asked about their opinions and beliefs compared to non-Hispanic whites (29.25% vs. 40.62%).
Additionally, patients in minority groups were less likely to feel their clinicians respected them compared to non-Hispanic whites (74.68% vs. 79.21%).
Being asked about opinions and beliefs was associated with feeling respected by clinicians, confirming findings of previous literature, Hicks and colleagues wrote.
Analysis also revealed that participants aged 65 years or older were more likely to feel respected compared with those aged 18 to 39 years, and participants with an associate degree were 22% less likely to report that they were “always” asked about their opinions or beliefs compared with people with less than a high school education.
Limitations included self-reported data; general nature of survey questions (ie, not asking about experiences with eye care professionals); non-inclusion of people in the Armed Forces, without residences and those who are institutionalized; a small proportion of participants in a minority group; and few included eye conditions.
Moving forward, Hicks and colleagues suggested future studies remedy these limitations, as well as examine more closely the correlation between race and ethnicity and being treated with respect and its implications for outcomes.
“If patients feel that they are not being treated with respect by their clinician, respect disparities will persist because research has shown that patients who feel that they have been disrespected by their clinician are more likely to wait to receive medical care and less likely to listen to the advice of their clinician,” they wrote. “Clinicians should understand that respect is not just associated with being nice to their patients, but also engaging with their patients and valuing them.”
Perspective
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The results of this survey-based study tell us that asking patients about their opinions and beliefs with regard to their health care is important in making them feel respected. While this study specifically hoped to evaluate whether racial and ethnic minorities felt respected by their clinicians, historically, we know that minorities and those of lower socioeconomic status are less likely to respond to surveys. Thus, the usefulness of these results with respect to that demographic can be partially questioned – indeed, they report that these minorities only accounted for 21.1% of the study population.
In addition, this only included patients who self-reported having an eye disease, which makes a lot of assumptions on the existing level of communication between the patient and clinician. What the study does reveal is that involving our patients in discussions about their care is important in making them feel respected – and presumably in improving how effectively we communicate with them. As we expand our cultural competency, we should be striving to overcome as many barriers as we can when it comes to communication. In this way, we can empower our patients and their support persons to take an active role in their health and be their own best advocates.
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