Black Americans with bipolar disorder receive poorer care than their White American counterparts. Racial bias and incongruence between psychiatrists' and patients' cultural explanations of illness may negatively influence psychiatrist-patient communications and contribute to disparities in care. This Mentored Patient-Oriented Research Career Development Award application (K-23), co-sponsored by Drs. Harold Alan Pincus and Debra Roter, is intended to provide an in-depth research and training experience to conduct systematic assessments of psychiatrists' communication skills. Research findings will be used to develop methods to improve psychiatrists' communication skills with Black Americans suffering from bipolar disorder. The award period will be used to develop qualitative and quantitative methods for systematically analyzing the influence of psychiatrists' communications on appointment outcomes.
The specific aims are: (i) apply and refine recruitment procedures to overcome barriers to communications research in psychiatry; (ii) evaluate the psychometric properties of the Roter Interaction Analysis System (RIAS) for use in psychiatry; (iii) quantitatively describe psychiatrists' communications in the context of clinical care; (iv) using the RIAS to measure communications, link quantitative differences in psychiatrists' communications with White versus Black bipolar disorder patients to differences in appointment outcomes; and (v) qualitatively investigate patients' views and opinions about their interactions with psychiatrists, patients' preferences for care including psychiatrists' decision-making style, as well as patients' illness beliefs and coping behaviors that influence their adherence decisions. Two quantitative studies and one qualitative study are proposed. The Seed study is a cross-sectional and observational study that aims to address methodological and logistical questions about performing psychiatric communications research. In contrast to the Seed study, Study 2 is a longitudinal and observational study specifically addressing the aim of this K23 award research proposal- to assess the influence of psychiatrists' communications on outcomes disparities in care between Black and White bipolar patients. Generalized Linear Mixed Modeling will be used in the statistical analyses of both studies. Study 3 will explore Study 2 patients' views and opinions about the audio taped appointment, patients' care preferences, preferences for psychiatrists' decision-making styles, and patients' illness beliefs and coping behaviors that influence their adherence decisions. Linking psychiatrists' communications to care outcomes has implications for the development of quality improvement interventions that could impact the treatment of patients with severe mental disorders.
