Center for Communication and Disparities Research
Ronald M. Epstein, M.D., Director
Professor of Family Medicine, Psychiatry and Oncology
Kevin Fiscella, M.D., MPH, Co-director
Professor of Family Medicine, Public Health Sciences and Oncology
The Center for Communication and Disparities Research and the University of Rochester Department of Family Medicine are national leaders in research on healthcare communication and health disparities, with over $18,604,896 in funding over the past 10 years from the National Institute of Health and other sources.
The mission of the Center is to improve health, advance health care quality and eliminate disparities in health and health care. Our research focuses on:
- Implementation and rigorous assessment of novel interventions to improve communication and reduce disparities
- Educating and training directed at health care professionals, patients, families and the community
- Communication among patients, families, physicians, and other health care professionals in health care settings
- Underserved and vulnerable populations
- Identifying and addressing pathways that produce and eliminate disparities in health and health care
The Center is housed in Family Medicine and actively collaborates with several departments and Centers at the University, including psychiatry, palliative care, public health sciences, and the Wilmot Cancer Center. The Center contributes to research that shows that effective communication can promote patient-, family- and relationship-centered care through:
- Strengthening healing relationships characterized by trust, caring, compassion, humility
- Improving health outcomes of acute, chronic, and life-limiting conditions
- Reducing the impact of racial, ethnic, disease-specific, and socioeconomic factors in care, and bridging differences in culture, class, and power
- Improving health behavior outcomes through lifestyle interventions
- Addressing end-of-life needs of people with serious and life-limiting conditions
- Improving the effectiveness of prevention and health promotion
The Center is a national and international model for cutting-edge translational research in communication and health, and a vehicle for dissemination of strategies to improve healthcare communication.
The Center addresses important gaps in communication involving patients, their families and friends and health care professionals and their effects on quality of care and health outcomes. We have a particular focus on inadequate communication between health professionals and socially marginalizes groups who report particular challenges, such as racial/ethnic minorities, the poor, people with low literacy and education, people affected by HIV/AIDS, refugees, and Deaf persons who use American Sign Language.
We focus on outcomes most likely to be affected by communication, such as (a) disease prevention and health promotion (b) chronic diseases including diabetes and hypertension, (c) acute illnesses, including pain control, morbidity following surgery, and length of hospital stay, (d) mental illnesses such as depression, and (e) end of life care. Importantly, we focus on interventions to improve communication in healthcare settings that lead to improvements in prevention, motivation for behavior change, adherence to treatment, as well as greater equity in health and healthcare for racial, ethnic, socioeconomic, educational and minority populations when compared to the general population.
We integrate four parallel trends in research and interventions on communication and health:
- Public health approaches have traditionally focused on the use of printed and electronic media to transmit health-related messages to populations. Our standardized patient study of ad-driven requests for prescription medication has documented the strong impact of the media on physician prescribing habits.
- Health professional training has focused on improving specific physician behaviors believed to improve patient adherence, participation in decision-making and feeling of having been understood. Current programs include an intervention to assess clinicians' efforts to promote physical activity in inner-city populations and an educational program for oncologists to improve communication in advanced cancer.
- Patient activation has focused on training patients and their families to assume a more active role in their care. Current programs provide question prompt lists and coaching to improve end-of-life care in cancer, and interactive media to promote effective communication in depression and HIV care.
- Health systems approaches develop new models and systems of care. Our patient navigator studies has examined the effect of providing better access to—and communication with—health care professionals on outcomes of care for patients with newly-diagnosed cancer. We are also testing the effect of primary care-community partnerships on diabetes prevention and lifestyle change for underserved adults.
The Center addresses health-related communication on several levels, including (a) the individual psychological makeup of physician and patient and potential for bias, (b) the 1:1 patient-clinician relationship, (c) the patient’s family and relevant social networks, (d) clinical communication among members the health care team, (e) communication with specific, targeted groups of patients, including the use of electronic media, (f) communication between health care researchers and those in clinical settings, (g) communication between the larger health care system and individual patients and populations and (h) communication between the health care system and the community.
- A Communication Intervention to Promote Physical Activity in Underserved Communities (Funded by the National Cancer Institute, Jennifer Carroll, PI)
- Affective Forecasting of Well-being in Cancer (Funded by the Department of Psychiatry Leonard F. Salzman Research Award, Michael Hoerger, PI)
- Communicating Prognosis in Advanced Illness (Funded by the Greenwall Bioethics Foundation, Robert Gramling, PI)
- Deaf Sign Language Users, Suicide and Social Network Characteristics (Funded by the NIH Office of the Director and administered by the National Institute on Deafness and Other Communication Disorders, Steven Barnett, PI)
- Feasibility of electronic health records tools to promote referral to community exercise programs (Funded by the National Cancer Institute, Jennifer Carroll, PI)
- Health Literacy Among Deaf American Sign Language Users and Cardiovascular Health Risk (Funded by the National Heart, Lung, and Blood Institute, Michael McKee, PI)
- Impact of a Novel Cancer Communication Intervention on Caregiver Bereavement (Funded by the National Cancer Institute/National Institute of Mental Health, Paul Duberstein, PI)
- Improving Research Consent with Deaf People who Communicate in Sign Language (Funded by the National Institute on Deafness and Other Communication Disorders and administered by the National Center for Advancing Translational Sciences, Thomas Pearson, PI)
- Mindful Practice: Focus on Serious and Life-Limiting Illness (Sponsored by Arnold P. Gold Foundation, Ronald Epstein, PI)
- Measuring "Goals of Care" Expression in Palliative Care Decision-Making Consultations (Funded by the University of Rochester Dean's Award, Robert Gramling, PI)
- MHREG for research in Ethnically Diverse Communities: Rochester PRIDE (Funded by the National Institute of Mental Health, Paul Duberstein, PI)
- President Grant (Sponsored by Arnold P. Gold Foundation, Ronald Epstein, PI)
- Prognosis Communication in Palliative Care (Funded by the National Palliative Care Research Center, Robert Gramling, PI)
- Randomized Control Trial of Patient, Caregiver and Physician Communication Coaching in Advanced Cancer (Funded by the National Cancer Institute, Ronald Epstein and Richard Kravitz, co-PIs)
- Social and Behavioral Influences in Cancer Communication and Care (Funded by the National Cancer Institute, Ronald Epstein and Cleveland Shields, co-PI's)
- Targeted and Tailored Messages to Improve Detection and Treatment of Depression in Primary Care (Funded by the National Institute of Mental Health, Richard Kravitz, PI)