Patients’ fear of discrimination drives health care delays

Author(s):

Austin Littrell

Key Takeaways

Perceived discrimination in healthcare settings leads to delayed care, particularly among younger adults and racial and ethnic minorities.
Effective patient-clinician communication can mitigate care delays associated with perceived discrimination.
Mediation analysis shows communication significantly influences the discrimination-care delay relationship, with the strongest impact on younger adults and minorities.
Enhancing communication, shared decision-making, and cultural competency can reduce patient apprehension and improve timely care-seeking behaviors.

Poor patient-clinician communication worsens care delays, especially for younger adults and racial minorities.

A new study published in JAMA Network Open suggests that patients who perceive discrimination in health care settings are more likely to delay seeking medical care due to nervousness. This trend is particularly prevalent among younger adults and racial and ethnic minorities. Patient-clinician communication plays a critical mediating role in this association, with findings suggesting that improving communication could help mitigate delays in care.

Researchers analyzed data from 25,581 adults with type 2 diabetes and/or hypertension who participated in the All of Us (AoU) Research Program between 2017 and 2022. Among them, 8.9% reported delaying medical care because they felt nervous about seeing a health care professional. The study found a strong association between perceived discrimination and care delays, with poor patient-clinician communication worsening the effect.

Mediation analysis revealed that patient-clinician communication significantly influenced the relationship between discrimination and care delays, with the strongest impact observed among younger adults — ages 18 to 44 — and racial and ethnic minority groups. Among this age group, the mediation proportions were highest for Hispanic (20.3%) and Black (19.5%) participants, followed by White (19.0%) and other racial and ethnic groups (18.3%).

The study underscores the importance of fostering effective and inclusive communication with patients — particularly those from historically marginalized groups. Enhancing shared decision-making, improving interpersonal communication and ensuring clarity in medical discussions may reduce patient apprehension and encourage timely care-seeking behaviors.

Prior research has consistently demonstrated that effective patient-provider communication enhances adherence to treatment plans and improves health outcomes. However, the latest findings highlight that communication also plays a role in mitigating the negative effects of perceived discrimination, which is a known barrier to health care access.

“By prioritizing better [communication], health care delays associated with patient apprehension related to perceived discrimination may be reduced,” the study’s authors wrote.

These findings reinforce the need to implement structural changes that prioritize patient trust and reduce biases in medical interactions. Some potential next steps for health care providers include:

Implementing cultural competency and bias training for all medical staff to help them recognize and address unconscious biases that may impact patient care.
Encouraging shared decision-making by involving patients more actively in their treatment plans, helping to build trust and reduce anxiety about medical visits.
Enhancing accessibility and inclusivity in patient education materials, ensuring that medical instructions and treatment options are communicated in ways that are culturally relevant and easy to understand.
Addressing systemic barriers to trust-building by fostering more patient-centered care models, diversifying the medical workforce, and ensuring accountability for discriminatory practices in health care settings.

As health care systems strive to reduce disparities in care and outcomes, ensuring that all patients feel comfortable seeking care without fear of discrimination remains a critical goal. The findings from this study reinforce the need for ongoing efforts to build trust and improve communication between health care providers and the diverse patient populations they serve.

Discrimination in medical settings is a longstanding issue, but studies like this provide a clearer understanding of its impact on health care-seeking behavior. Addressing these disparities is not only an ethical obligation but also a necessary step toward improving public health outcomes across all demographics.

The evidence suggests that small changes in how providers communicate with patients could lead to significant improvements in care access and adherence, ultimately helping to bridge the gap in health equity.