Determinants effecting trust in the family planning encounter

Awarded 2014
Complex Family Planning Fellowship Research
Treasure Walker, MD
New York University School of Medicine

Background: The history of reproductive injustice in the United States against women and girls of color is well-documented. As a result, women of color mistrust and are suspicious of medical professionals in reproductive health care. The conditions of mistrust and suspicion are further worsened by the disparity that affects women of color in family planning. Women of color make up 55% of unintended pregnancy in the U.S, have higher rates of less-effective contraception use, and higher rates of method failure. To improve disparities, more attention should focus on the relationship between patient and provider. In particular, race/ethnicity of the patient and the provider and how each affects the family planning encounter are of interest. Whether physicians and patients share or differ by race is described as concordant, or discordant.  In the primary care literature, the data shows that concordance is positively associated with patients’ perceptions of their relationships with physicians and even specifically indicates more satisfaction with care. The obstetrics and gynecology literature has not explored the role of race/ethnicity concordance in the relationship between patient and physician, and its potential effects on receipt of care.

Objectives: To evaluate the effect of race/ethnicity concordance between physicians and patients on patient satisfaction at the time of consultation for abortion.
To evaluate the effect of race/ethnicity concordance between physicians and patients on patients’ level of trust in the physician at the time of consultation for abortion. 
Methods: The primary research design is a cross-sectional survey of a racially and ethnically diverse population of patients at Bellevue Hospital in the women’s ambulatory care center. This design will focus only on the initial consultation, where the patient will be making decisions about how to proceed with planning for abortion and subsequent contraception. The participants in this study will be recruited from the population of women seeking elective termination services at Bellevue Hospital for non-anomalous pregnancies of gestational age up to 24 weeks 0 days. Both the Scale of Patient Overall Satisfaction and scale of Patient Trust in Physician are validated, with higher scores indicating more satisfaction and more trust, respectively. 
Expected Results: We hypothesize that race/ethnicity concordance will be associated with higher patient satisfaction and higher trust in the physician.