Past research has shown when it comes to certain diseases and medications, not all racial and ethnic groups respond the same. Is it possible, then, that race and ethnicity determine how likely patients are to elect aggressive end-of-life treatments? The short answer is yes, according to a new study from the University of Pittsburgh. The study found doctors give less sympathetic, non-verbal cues to seriously ill black patients, which leads to poor communication and higher rates of aggressive, life-sustaining measures for terminal illness. 

Researchers wanted to observe interactions during end-of-life interactions, so in the first study, they tested whether 33 attending emergency medicine physicians and other health care workers based in Allegheny County, Pa., used different verbal and/or non-verbal communication with black and white actor-patients. Accompanied by a family member, these actor-patients portrayed comparable medical conditions, such as metastatic gastric or pancreatic cancer, and read from matching scripts. The physicians themselves were not aware of what researchers were looking for.

Researchers analyzed audio and video recordings of the encounters, which included coding verbal emotion-handling and shared decision-making behaviors, as well as non-verbal behaviors including time spent with a patient and/or surrogate; open versus closed posture; touching the patient; and physical proximity. The researchers also made a statistical examination of the doctors' summed verbal and non-verbal communication scores to compare their treatment of black and white patients. Because the majority of physicians were white men, no conclusions could be drawn about whether a physician's race influenced his or her actions.

Racial Differences

The researchers found physicians averaged 7 percent lower scores for their nonverbal interactions with black patients than they did with white patients.

"When explaining what was happening and what the next steps for care could be, with the white patients, the physicians were more likely to stand right at the patient's bedside and touch them in a sympathetic manner," said Dr. Amber Barnato, an associate professor of clinical and translation medicine at Pitt's School of Medicine, in the news release.

Speaking with black patients, physicians were more likely to stay near the door and hold a binder in front of them, the researchers discovered; this may be perceived by the patient and family as defensive or disengaged. These subconscious actions may have a significant implication, too, such as black patients believing their doctor does not have their best interest in mind.

Moreover, black patients are much more likely than whites to request aggressive treatment options when making this decision in the hospital rather than in the community.

"When you survey people in the community about their feelings on end-of-life care, blacks are only slightly more likely than whites to say they want aggressive, life-sustaining measures when terminally ill," said Barnato.

In a separate study, researchers from the University of South Carolina examined the impact race had on both a physician's and patient's body language during medical interviews, where patients were aged 65 years or older. Here, researchers found white physicians gazed at their white patients more than they did black patients. Meanwhile, compared to other doctor-patient combinations, black physicians with black patients appeared more open, while smiling and touching the patient more. And black physicians with white patients spent less time in open body communication, but they did smile more frequently and maintain more consistent eye contact.

These studies suggest race can affect non-verbal communication in medical settings, though overall, it's still poorly understood. However, at least one thing is certain: body language is essential in building trust, whether at home, work, school — or even a doctor’s office.  

Sources: Elliot AM, Alexander SC, Mescher CA et al. Differences in Physicians' Verbal and Nonverbal Communication With Black and White Patients at the End of Life. Journal of Pain and Symptom Management. 2016.

Stepanikova I, Zhang Q, Wieland D et al. Non-Verbal Communication Between Primary Care Physicians and Older Patients: How Does Race Matter? Journal of General Internal Medicine. 2011.