a small study in JAMA Dermatology suggests.
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Lead author Kristina Gorbatenko-Roth, PhD, of the department of psychology at University of Wisconsin-Stout, Menomonie, Wis., and colleagues analyzed the perceptions of 19 black, adult patients who had received treatment in a skin of color clinic (SOCC). Patients were asked about their perspectives and experiences inside and outside of the clinic as it pertained to dermatologists’ interaction style, cultural awareness, and overall treatment. Two focus groups consisted of patients seen by a race-concordant dermatologist, and two focus groups consisted of patients seen by a race-discordant dermatologist. The patients also responded to a survey.
Of 19 adult black patients who participated in the study, 18 respondents were women, and the mean age was 50 years. Compared with non-SOCC dermatology treatment experiences, patients experienced higher levels of overall satisfaction with SOCC dermatologists, reporting that SOCC dermatologists were better trained to care for black patients, showed greater respect and dignity, and were more trustworthy, according to the study published Aug 21.
Care satisfaction appeared most related to doctors’ interpersonal style and specialized knowledge of black skin and hair, according to the study. Investigators gleaned nine major themes during the analysis, five of which included dermatologist behaviors: interaction style, knowledge, partnering with patients in focusing on outcomes, economic sensitivity, and shared life experiences. Four themes were specific to patients: comfort, confidence, education, and concordance preference. Across all participants, a dermatologist’s interaction style was identified as the most important factor, elements of which included oral communication, body language, and physical examination performance.
Regarding experiences outside the SOCC, participants reported that some providers performed only a cursory skin examination and appeared to avoid physical contact, which some patients interpreted as a sign of disrespect and a lack of racial sensitivity. Participants also expressed frustration with dermatologists outside the clinic who seemed to lack knowledge about black skin and hair disorders. Of all respondents, 71% reported they would prefer a black (or race concordant) dermatologist, including 91% of the race-concordant group and 33% of the race-discordant group.
The investigators wrote the findings underscore a number of needed changes to enhance the care of black dermatology patients, including enhanced dermatology residency and workforce education about treatment of skin of color and more training on culturally aware communication skills. Perceptions of racial and cost-of-care insensitivities identified by the study population also suggest the need for training in cultural competency and implicit bias, delivery of cost conscious care, and the social determinants of health.
As far as they know, the authors noted that, before this study, “little was known regarding black patients’ perceptions of their dermatology care, either within or external to an SOCC,” and that the study “appears to be the first to investigate and provide preliminary findings for addressing this knowledge gap.”
SOURCE: Gorbatenko-Roth K et al. JAMA Dermatol. 2019 Aug 21. doi: 10.1001/jamadermatol.2019.2063.