title: Orthopedic communication about osteoarthritis treatment: Does patient race matter?
abstract: OBJECTIVE
  To understand racial disparities in the use of total joint replacement, we examined whether there were racial differences in patient-provider communication about treatment of chronic knee and hip osteoarthritis in a sample of African American and white patients referred to Veterans Affairs orthopedic clinics.
  
  
  METHODS
  Audio recorded visits between patients and orthopedic surgeons were coded using the Roter Interaction Analysis System and the Informed Decision-Making model. Racial differences in communication outcomes were assessed using linear regression models adjusted for study design, patient characteristics, and clustering by provider.
  
  
  RESULTS
  The sample (n = 402) included 296 white and 106 African American patients. Most patients were men (95%) and ages 50-64 years (68%). Almost half (41%) reported an income <$20,000. African American patients were younger and reported lower incomes than white patients. Visits with African American patients contained less discussion of biomedical topics (β = -9.14; 95% confidence interval [95% CI] -16.73, -1.54) and more rapport-building statements (β = 7.84; 95% CI 1.85, 13.82) than visits with white patients. However, no racial differences were observed with regard to length of visit, overall amount of dialogue, discussion of psychosocial issues, patient activation/engagement statements, physician verbal dominance, display of positive affect by patients or providers, or discussion related to informed decision making.
  
  
  CONCLUSIONS
  In this sample, communication between orthopedic surgeons and patients regarding the management of chronic knee and hip osteoarthritis did not, for the most part, vary by patient race. These findings diminish the potential role of communication in Veterans Affairs orthopedic settings as an explanation for well-documented racial disparities in the use of total joint replacement.
authors.affiliation: VA Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, Pennsylvania, USA. leslie.hausmann@gmail.com
authors.forename: Leslie R M
authors.initials: LR
authors.lastname: Hausmann
authors.forename: Barbara H
authors.initials: BH
authors.lastname: Hanusa
authors.forename: Denise M
authors.initials: DM
authors.lastname: Kresevic
authors.forename: Susan
authors.initials: S
authors.lastname: Zickmund
authors.forename: Bruce S
authors.initials: BS
authors.lastname: Ling
authors.forename: Howard S
authors.initials: HS
authors.lastname: Gordon
authors.forename: C Kent
authors.initials: CK
authors.lastname: Kwoh
authors.forename: Maria K
authors.initials: MK
authors.lastname: Mor
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Hannon
authors.forename: Peter Z
authors.initials: PZ
authors.lastname: Cohen
authors.forename: Richard
authors.initials: R
authors.lastname: Grant
authors.forename: Said A
authors.initials: SA
authors.lastname: Ibrahim
mesh_terms: D001741:Black or African American / Q000523:psychology; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data*; D016009:Chi-Square Distribution; D016000:Cluster Analysis; D003142:Communication; D005260:Female; D054625:Healthcare Disparities; D006787:Hospitals, Veterans; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D009820:Ohio; D015207:Osteoarthritis, Hip / Q000208:ethnology / Q000523:psychology / Q000601:surgery*; D020370:Osteoarthritis, Knee / Q000208:ethnology / Q000523:psychology / Q000601:surgery*; D010414:Pennsylvania; D010817:Physician-Patient Relations; D013997:Time Factors; D044465:White People / Q000523:psychology