Poor Patient-Clinician Communication Linked to Diabetes Care Delays

A critical link between perceived discrimination in health care settings and delays in seeking diabetes care has been identified in a new study.¹ The study found that poor patient-clinician communication (PCC) mediated this association, with the strongest impact seen among younger adults and racial and ethnic minority groups.

The cross-sectional study is published in JAMA Network Open.

“Importantly, our study builds upon existing studies by showing that communication, specifically shared medical decision-making and clarity of information, may explain the association between discrimination and health care delays due to feeling nervous about visiting a health care professional,” wrote the researchers of the study. “This mediation effect was stronger for younger adult and racial and ethnic minority patients.”

Additionally, a previous study found young adults with type 2 diabetes (T2D) with low incomes had a higher mortality risk and poorer adherence to medication regimens and preventive health measures.²

Study finds perceived discrimination in health care leads to delayed visits, especially among younger and minority patients. | Image credit: Dragana Gordic - stock.adobe.com

The study utilized data collected between May 31, 2017, and April 30, 2022, to examine the role of PCC as a mediating factor between perceived discrimination in health care settings (PDHS) and delays in seeking medical care due to nervousness. The study population included adults 18 years or older diagnosed with T2D and/or hypertension. The primary outcome measured was self-reported delays in care due to apprehension about seeing a health care professional.

The cohort included 25,851 adults with a mean (SD) age of 62.4 (12.8) years. Of these patients, 41.3% identified as men, 58.1% as women, and 0.5% as nonbinary, transgender, or other gender. Most participants self-reported a White race (81.3%), with smaller populations self-reporting Black (9.5%), Hispanic (6.3%), and other racial and ethnic groups (2.9%).

Among participants, 8.9% reported delaying health care due to nervousness about seeing a provider. Higher levels of PDHS were significantly associated with increased health care delays (β = 0.35; 95% CI, 0.27-0.43; P < .001). Poorer PCC also contributed to these delays (β = 0.25; 95% CI, 0.21-0.28; P < .001), and PDHS was significantly linked to poorer PCC (β = 0.33; 95% CI, 0.30-0.36; P < .001).

Additionally, the analysis showed that PCC partially explained the relationship between PDHS and health care delays, with the strongest mediation effects observed among younger and minority participants. Hispanic individuals exhibited the highest mediation proportions across all age groups, followed by Black, White, and other racial and ethnic groups.

The researchers noted several limitations to the study. First, its cross-sectional design prevented causal inference and relied on self-reported survey data, leading to potential response and social desirability biases. Second, electronic health record data were only available for participants linked to All of Us–funded health care organizations. Lastly, despite adjusting for sociodemographic factors, unmeasured variables such as health literacy, health care navigation, and language proficiency may have influenced the findings.

Despite these limitations, the researchers believe the findings suggest that improving PCC could help reduce health care delays driven by patient apprehension related to discrimination among patients with T2D.

“Poor PCC mediated this association, with the extent of mediation varying across age and racial and ethnic groups,” wrote the researchers. “Addressing discrimination in the health care system is essential to encouraging timely health care–seeking behaviors, particularly for patients requiring regular care. Improving PCC is equally crucial to reducing health care delays that may stem from nervousness.”

References

1. Jafari Bidgoli M, Wang H, Macander C, et al. Perceived discrimination in health care settings and care delays in patients with diabetes and hypertension. JAMA Netw Open. 2025;8(3):e250046. doi:10.1001/jamanetworkopen.2025.0046

2. Klein H. Young adults with low incomes have higher diabetes mortality risk. AJMC^®. November 14, 2024. Accessed March 14, 2025. https://www.ajmc.com/view/young-adults-with-low-incomes-have-higher-diabetes-mortality-risk