Assessing Patient-provider Interactions During the Preoperative Anesthesia Consult

NCT04508543 | Completed

• 1 other identifier: Study00022536
• Study Type: observational
• Target: 110
• Locations: 1 country
• Sites: 1

Brief Summary

This will be a prospective, observational, single-center study to evaluate the effect of race and ethnicity on anesthesia provider-patient interactions. The investigators will also attempt to validate a new tool for assessing non-verbal communication during the preanesthesia consult. Masking:

1. 1.Patient
2. 2.Anesthesia providers (attending anesthesiologist and resident or Certified Registered Nurse Anesthetist)

Conditions

Racism; Healthcare Disparities; Minority Health

Keywords

Implicit Bias; Unconscious Bias; Racial disparities; Non-verbal communication; Anesthesia

Outcome Measures

Primary Outcomes (1)

• Nonverbal Communication Score (NCS score, range 0-4)

  The score is a sum of four components, each contribute to a score range 0 - 1. 1\) Percent time spent with open body language: defined as the anesthesia provider facing the patient and not placing anything between the anesthesia provider and the patient. 2) Percent time spent interacting with the patient or surrogate: Time spent interacting with the patient is defined as time the physician made eye contact with the patient or surrogate. Time spent talking to the patient, but not making eye contact will not be counted. Eye contact made during the physical examination will be counted. 3) Distance from the patient along the long axis of the patient's body (distance from the head) which will be assessed 15 seconds after the physician enters the preanesthesia bay. 4) Distance from the patient along the axis perpendicular to the patient's body (distance from the handrail).

  1 hour

Secondary Outcomes (3)

• Non-Verbal Communication and Patient Medical Risk

  8 hours

• NCS and Surgical Risk

  8 hours

• Anesthesia Provider Observes Outcome Assessor

  8 hours

Other Outcomes (4)

• Evaluate following based on Non-Verbal Communication and Anesthesia Decision Making

  8 hours

• Total Parenteral Morphine Equiv. Administered

  8 hours

• Duration of Preanesthesia Anesthesia Consult

  1 hour

Study Arms (2)

Minority (Case)

Self-identified as being a member of group traditionally underrepresented in the medical profession relative to the proportion in the general population: African-American/Black, Mexican-American, Native American (American Indians, Alaska Natives, and Native Hawaiians), and mainland Puerto Rican.

Other: Non-verbal communication score

Caucasian (Control)

Self-identified as Caucasian and Non-Hispanic

Other: Non-verbal communication score

Interventions

Non-verbal communication score OTHER

1\. To compare nonverbal communication score (NCS, range 0 - 4) between minority and Caucasian non-Hispanic patients. The score is a sum of four components, each contribute to a score range 0 - 1. The four components are: percent time spent with open body language, percent time spent interacting with the patient or surrogate, distance from the patient along the long axis of the patient's body (distance from the head), and distance from the patient along the axis perpendicular to the patient's body (distance from the handrail).

Caucasian (Control); Minority (Case)

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Probability Sample

Study Population

Patients greater than or equal to 18 years old or greater, undergoing surgery and/or a surgical procedure in the South Operating Rooms at Oregon Health \& Science University and possessing the capacity for consent, including minorities and Women of all racial/ethnic groups.

You may qualify if:

• years of age or greater
• Having surgery in the South Operating Rooms of Oregon Health \& Science University
• Possessing the capacity for consent

You may not qualify if:

• Children
• Vulnerable populations including prisoners and decisionally impaired adults

Sponsors & Collaborators

• Oregon Health and Science University: lead

Study Sites (1)

Oregon Health and Science University

Portland, Oregon, 97239, United States

Location

Related Publications (15)

• FitzGerald C, Hurst S. Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics. 2017 Mar 1;18(1):19. doi: 10.1186/s12910-017-0179-8.

  PMID: 28249596 BACKGROUND

• Elliott AM, Alexander SC, Mescher CA, Mohan D, Barnato AE. Differences in Physicians' Verbal and Nonverbal Communication With Black and White Patients at the End of Life. J Pain Symptom Manage. 2016 Jan;51(1):1-8. doi: 10.1016/j.jpainsymman.2015.07.008. Epub 2015 Aug 20.

  PMID: 26297851 BACKGROUND

• Hall WJ, Chapman MV, Lee KM, Merino YM, Thomas TW, Payne BK, Eng E, Day SH, Coyne-Beasley T. Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review. Am J Public Health. 2015 Dec;105(12):e60-76. doi: 10.2105/AJPH.2015.302903. Epub 2015 Oct 15.

  PMID: 26469668 BACKGROUND

• Sabin J, Nosek BA, Greenwald A, Rivara FP. Physicians' implicit and explicit attitudes about race by MD race, ethnicity, and gender. J Health Care Poor Underserved. 2009 Aug;20(3):896-913. doi: 10.1353/hpu.0.0185.

  PMID: 19648715 BACKGROUND

• AAMC. Percentage of all active physicians by race/ethnicity, 2018. Association of American Medical Colleges. https://www.aamc.org/data-reports/workforce/interactive-data/figure-18-percentage-all-active-physicians-race/ethnicity-2018. Published 2019. Accessed April 6, 2020, 2020.

  BACKGROUND

• AAMC. Underrepresented in Medicine Definition. Association of American Medical Colleges. https://www.aamc.org/what-we-do/mission-areas/diversity-inclusion/underrepresented-in-medicine. Published 2004. Accessed March 10, 2020, 2020.

  BACKGROUND

• Hagiwara N, Slatcher RB, Eggly S, Penner LA. Physician Racial Bias and Word Use during Racially Discordant Medical Interactions. Health Commun. 2017 Apr;32(4):401-408. doi: 10.1080/10410236.2016.1138389. Epub 2016 Jun 16.

  PMID: 27309596 BACKGROUND

• Hagiwara N, Mezuk B, Elston Lafata J, Vrana SR, Fetters MD. Study protocol for investigating physician communication behaviours that link physician implicit racial bias and patient outcomes in Black patients with type 2 diabetes using an exploratory sequential mixed methods design. BMJ Open. 2018 Oct 18;8(10):e022623. doi: 10.1136/bmjopen-2018-022623.

  PMID: 30341127 BACKGROUND

• Blair IV, Steiner JF, Fairclough DL, Hanratty R, Price DW, Hirsh HK, Wright LA, Bronsert M, Karimkhani E, Magid DJ, Havranek EP. Clinicians' implicit ethnic/racial bias and perceptions of care among Black and Latino patients. Ann Fam Med. 2013 Jan-Feb;11(1):43-52. doi: 10.1370/afm.1442.

  PMID: 23319505 BACKGROUND

• Penner LA, Dovidio JF, Gonzalez R, Albrecht TL, Chapman R, Foster T, Harper FW, Hagiwara N, Hamel LM, Shields AF, Gadgeel S, Simon MS, Griggs JJ, Eggly S. The Effects of Oncologist Implicit Racial Bias in Racially Discordant Oncology Interactions. J Clin Oncol. 2016 Aug 20;34(24):2874-80. doi: 10.1200/JCO.2015.66.3658. Epub 2016 Jun 20.

  PMID: 27325865 BACKGROUND

• Maina IW, Belton TD, Ginzberg S, Singh A, Johnson TJ. A decade of studying implicit racial/ethnic bias in healthcare providers using the implicit association test. Soc Sci Med. 2018 Feb;199:219-229. doi: 10.1016/j.socscimed.2017.05.009. Epub 2017 May 4.

  PMID: 28532892 BACKGROUND

• Schulman KA, Berlin JA, Harless W, Kerner JF, Sistrunk S, Gersh BJ, Dube R, Taleghani CK, Burke JE, Williams S, Eisenberg JM, Escarce JJ. The effect of race and sex on physicians' recommendations for cardiac catheterization. N Engl J Med. 1999 Feb 25;340(8):618-26. doi: 10.1056/NEJM199902253400806.

  PMID: 10029647 BACKGROUND

• Haider AH, Schneider EB, Sriram N, Dossick DS, Scott VK, Swoboda SM, Losonczy L, Haut ER, Efron DT, Pronovost PJ, Lipsett PA, Cornwell EE 3rd, MacKenzie EJ, Cooper LA, Freischlag JA. Unconscious race and social class bias among acute care surgical clinicians and clinical treatment decisions. JAMA Surg. 2015 May;150(5):457-64. doi: 10.1001/jamasurg.2014.4038.

  PMID: 25786199 BACKGROUND

• Goyal MK, Johnson TJ, Chamberlain JM, Casper TC, Simmons T, Alessandrini EA, Bajaj L, Grundmeier RW, Gerber JS, Lorch SA, Alpern ER; Pediatric Care Applied Research Network (PECARN). Racial and Ethnic Differences in Antibiotic Use for Viral Illness in Emergency Departments. Pediatrics. 2017 Oct;140(4):e20170203. doi: 10.1542/peds.2017-0203. Epub 2017 Sep 5.

  PMID: 28872046 BACKGROUND

• Obeidat SS, Rakshe S, Fareh R, Norris K, Ye S, Zuo LW, Togioka BM. Impact of Unconscious Race Bias Among Anesthesia Providers on Nonverbal Communication During the Preoperative Anesthesia Consult: A Prospective, Observational Study. J Racial Ethn Health Disparities. 2025 Aug 22. doi: 10.1007/s40615-025-02604-5. Online ahead of print.

  PMID: 40844570 DERIVED

MeSH Terms

Conditions

Racism; Bias, Implicit; Nonverbal Communication

Condition Hierarchy (Ancestors)

Prejudice; Social Behavior; Behavior; Social Discrimination; Communication

Study Officials

• Brandon M Togioka, MD

  Oregon Health and Science University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: August 7, 2020
• First Posted: August 11, 2020
• Study Start: December 7, 2021
• Primary Completion: February 11, 2022
• Study Completion: February 10, 2025
• Last Updated: February 13, 2025

Record last verified: 2025-02

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)