Patient Education and Counseling 96 (2014) 143
Contents lists available at ScienceDirect
Patient Education and Counseling journal homepage: www.elsevier.com/locate/pateducou
Editorial
An unequal burden
In this issue of Patient Education and Counseling we publish a study by Carlton Haywood Jr. (first author), Mary Catherine Beach (senior author) and their colleagues at The Johns Hopkins School of Medicine about the experiences of sickle cell disease (SCD) patients regarding their relations to health care providers [1]. The authors found that the SCD patients in their sample reported relatively high levels of dissatisfaction with the extent to which healthcare providers spend enough time with them, listen carefully to them and shows sufficient respect. A potential explanation could be that most SCD patients in the United States are African American. The authors point to prior research that more African American than Caucasian patients report poor communication with providers [2]. However, the authors found that SCD patients in their sample reported more poor communication with providers than patients in a national African-American sample did. The authors conclude that ‘‘the communication difficulties experienced by persons with SCD do not appear reducible to their predominantly AfricanAmerican race, but may result from more disease specific factors ([1] p. 159)’’. The study is important for at least two reasons. First, the paper is an example of a study which reflects the growing concern about disparities in the quality of healthcare in general and patient– provider communication in particular due to factors such as race, economic resources, education and health status. But second, and perhaps more importantly, Haywood et al.’s study points out that race alone does not explain why many SCD patients in their sample report shortcomings in providers’ communication practices. The authors discuss potential disease specific factors as explanations of less patient satisfaction with providers’ communication behavior and state that one such factor could be the common complaint of pain that lacks objective findings. In this respect SCD patients share characteristics with other patient categories with a high degree of subjective suffering,
http://dx.doi.org/10.1016/j.pec.2014.06.012 0738-3991/ß 2014 Published by Elsevier Ireland Ltd.
but few objective findings. Page and Wessely have for instance argued how inadequate communication practices may exacerbate symptoms in patients with so-called medically unexplained symptoms [3]. The title of Haywood et al.’s paper is ‘‘An unequal burden’’. Many patients in their sample seem to suffer from a double, or even a triple burden: the disease itself, the healthcare disparities due to socioeconomic factors, and finally the potential problems related to unhelpful communication practices in the treatment of pain and other symptoms with few objective findings. The findings in Haywood et al.’s study may therefore serve as a reminder that some patients are more vulnerable than others with respect to provider–patient communication. It is an important task for clinical communication research to identify potentially vulnerable patient groups, and which factors that may explain poor provider– patient communication patterns. An increased knowledge, insight and attention to such disparities is important for healthcare providers in order to make us all more conscious of potential biases in our clinical work, and for communication skills trainers in order to promote communication practices which overcome the unequal burden for vulnerable patient group. References [1] Haywood Jr C, Bediako S, Lanzkron S, Diener-West M, Strouse J, Haythornwaite J, et al. An unequal burden: poor patient–provider communication and sickle cell disease. Patient Educ Couns 2014;96:159–64. [2] 2011 National Healthcare Disparities Report; 2012. [3] Page LA, Wessely S. Medically unexplained symptoms: exacerbating factors in the doctor–patient encounter. J R Soc Med 2003;96:223–7.
Arnstein Finset Patient Education and Counseling E-mail address: arnstein.fi[email protected]
Contents lists available at ScienceDirect
Patient Education and Counseling journal homepage: www.elsevier.com/locate/pateducou
Editorial
An unequal burden
In this issue of Patient Education and Counseling we publish a study by Carlton Haywood Jr. (first author), Mary Catherine Beach (senior author) and their colleagues at The Johns Hopkins School of Medicine about the experiences of sickle cell disease (SCD) patients regarding their relations to health care providers [1]. The authors found that the SCD patients in their sample reported relatively high levels of dissatisfaction with the extent to which healthcare providers spend enough time with them, listen carefully to them and shows sufficient respect. A potential explanation could be that most SCD patients in the United States are African American. The authors point to prior research that more African American than Caucasian patients report poor communication with providers [2]. However, the authors found that SCD patients in their sample reported more poor communication with providers than patients in a national African-American sample did. The authors conclude that ‘‘the communication difficulties experienced by persons with SCD do not appear reducible to their predominantly AfricanAmerican race, but may result from more disease specific factors ([1] p. 159)’’. The study is important for at least two reasons. First, the paper is an example of a study which reflects the growing concern about disparities in the quality of healthcare in general and patient– provider communication in particular due to factors such as race, economic resources, education and health status. But second, and perhaps more importantly, Haywood et al.’s study points out that race alone does not explain why many SCD patients in their sample report shortcomings in providers’ communication practices. The authors discuss potential disease specific factors as explanations of less patient satisfaction with providers’ communication behavior and state that one such factor could be the common complaint of pain that lacks objective findings. In this respect SCD patients share characteristics with other patient categories with a high degree of subjective suffering,
http://dx.doi.org/10.1016/j.pec.2014.06.012 0738-3991/ß 2014 Published by Elsevier Ireland Ltd.
but few objective findings. Page and Wessely have for instance argued how inadequate communication practices may exacerbate symptoms in patients with so-called medically unexplained symptoms [3]. The title of Haywood et al.’s paper is ‘‘An unequal burden’’. Many patients in their sample seem to suffer from a double, or even a triple burden: the disease itself, the healthcare disparities due to socioeconomic factors, and finally the potential problems related to unhelpful communication practices in the treatment of pain and other symptoms with few objective findings. The findings in Haywood et al.’s study may therefore serve as a reminder that some patients are more vulnerable than others with respect to provider–patient communication. It is an important task for clinical communication research to identify potentially vulnerable patient groups, and which factors that may explain poor provider– patient communication patterns. An increased knowledge, insight and attention to such disparities is important for healthcare providers in order to make us all more conscious of potential biases in our clinical work, and for communication skills trainers in order to promote communication practices which overcome the unequal burden for vulnerable patient group. References [1] Haywood Jr C, Bediako S, Lanzkron S, Diener-West M, Strouse J, Haythornwaite J, et al. An unequal burden: poor patient–provider communication and sickle cell disease. Patient Educ Couns 2014;96:159–64. [2] 2011 National Healthcare Disparities Report; 2012. [3] Page LA, Wessely S. Medically unexplained symptoms: exacerbating factors in the doctor–patient encounter. J R Soc Med 2003;96:223–7.
Arnstein Finset Patient Education and Counseling E-mail address: arnstein.fi[email protected]
