Communication Barriers Between Hispanic RA Patients & Rheumatologists May Be Due to Social Desirability Bias

Hispanic patients with Rheumatoid Arthritis (RA) show social-desirability bias during physician-patient interactions making it challenging to find true concordance and impossible to use patient-provider questionnaires (PPQs) filled out by rheumatologists as a substitute for patient assessments, according to research published in the Annals of Rheumatic Disease.

Dr. Hernandez and colleagues carried out a survey to understand if rheumatologists and patient assessments for Hispanic/Latinx people with RA were in agreement when using a Spanish-language digital PPQ. Furthermore, they determined if a Spanish-language rheumatologist-completed PPQ could be a proxy for patient impressions in a prospective clinical study.

The Survey was made available on tablet devices in 4 US and Puerto Rico rheumatology clinics. The patient’s response was graded with scores of 5 (strongly agree), 4 (agree), or 3 (Neither agree nor disagree). Across the 114 clinical visits, the researchers found that 96.75% of the answers recorded were almost invariably positive, with 88% of the responders responding with scores of 5, 12% with a score of 4, or 0.09% with scores of 3.

Furthermore, the researchers found that physicians responded with 4 (agree) more often than patients (18% vs. 6% of responses). When the answers were paired, they showed high concordance–about eighty percent of the answers were the same from both patients and physicians. The researchers suggested this was the result of social desirability bias, or the tendency to respond in a way the respondent knows will be viewed favorably.

To further understand the impact of the research, Rheumatology advisers spoke with the lead study author, Dr. Daniel Hernandez, MD. 

Dr. Hernandez cited a lack of attainable goals when asked why patients sometimes feel the need to over-report positive physician interactions over negative interactions.

“What might be happening is that patients and physicians are setting goals that are not attainable and are therefore ignored, or they are not setting goals at all, which causes an over-reporting of positive responses,” Dr. Hernandaz.

To ensure physicians acknowledge and understand patient concerns, Dr. Hernandez suggests that rheumatologists work as a team with their patients and ensure that everyone understands symptoms and treatment options. 

For patients whose first language is not English, Dr. Hernandez recommends that the practice should make efforts to provide comprehensive translation services to ensure that vital information is not misunderstood.

 

Source: Rheumatology Advisor

Journal: BMJ