Racial differences in patient-provider communication, patient self-efficacy, and their associations with lupus-related damage: a cross-sectional survey

Objective Despite significant racial disparities in systemic lupus erythematosus (SLE) outcomes, few studies have examined how disparities may be perpetuated in the clinical encounter. We aimed to explore associations between areas of clinical encounter – patient-provider communication and patient self-efficacy – with SLE-related damage, in order to identify potential areas for intervention to reduce SLE outcome disparities.

Methods We collected cross-sectional data from a tertiary lupus clinic including patient-provider communication, general self-efficacy, self-efficacy for managing medications and treatments, patient-reported health status, and clinical information. We compared racial groups and used logistic regression to assess race-stratified association of patient-provider communication and patient self-efficacy with having SLE-related damage.

Results Among 121 patients (36% Caucasian, 64% African-American), African-Americans were younger, more likely to be on Medicaid, and less likely to be college educated, married, or living with a partner or spouse. African-Americans reported less fatigue and better social health, took more complex SLE medication regimens, had lower fibromyalgia scores, and higher SLE disease activity and SLE-related damage scores. African-Americans reported more hurried communication with providers, reflected through perceiving providers used difficult words, but similar self-efficacy compared to Caucasians. Perceiving providers use difficult words and lower general self-efficacy were associated with having SLE-related damage among African- Americans but not Caucasians.

Conclusion African-Americans had more severe SLE and perceived more hurried communication with providers. Both worse communication and lower self-efficacy were associated with having SLE-related damage among African-Americans but not Caucasians, suggesting that these factors should be investigated as potential interventions to reduce SLE racial disparities.