Hospital-based physicians exhibit significantly fewer positive, rapport-building nonverbal cues with black patients than with white patients when discussing end-of-life care, according to a small study published in the Journal of Pain and Symptom Management.

“Although we found that physicians said the same things to their black and white patients, communication is not just the spoken word. It also involves nonverbal cues, such as eye contact, body positioning, and touch,” said senior author Amber Barnato, MD, MPH, associate professor of clinical and translational medicine at the University of Pittsburgh School of Medicine. “Poor nonverbal communication—something the physician may not even be aware he or she is doing—could explain why many black patients perceive discrimination in the health care setting.”

Because black patients are more likely than white patients to die in the intensive care unit with life-sustaining treatments, researchers hypothesized that differences in patient- and/or surrogate-provider communication may contribute to this disparity. Therefore, researchers at the University of Pittsburgh School of Medicine sought to evaluate whether hospital-based physicians use different verbal and/or nonverbal communication with black and white simulated patients and their surrogates.

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For the study, researchers recruited 33 attending emergency medicine physicians, hospitalists, and intensivists and put them in simulations where actors portrayed terminally ill black and white patients who were experiencing plummeting vital signs related to either metastatic gastric or pancreatic cancer.

Results showed that there was no difference in verbal communication with respect to patient race (P=.958), but researchers found that nonverbal communication scores were significantly lower with the black patients than with the white patients (P=.014).

“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. “However, blacks are much more likely than whites to request such care when they are faced with making the decision in the hospital. Body language is a significant tool in building trust—or mistrust—and physicians need to ensure that their body language isn’t contributing to that decision.”

“To help black patients and their families feel welcome and encouraged to be partners in medical decision-making, it is critical that doctors be aware of their verbal and nonverbal communication and any unintentional biases.”


Racial bias may be conveyed by doctors’ body language [news release]. EurekAlert! Web site. Posted January 4, 2016. Accessed January 5, 2016.