Thursday, April 21, 2022

DSM Cultural Formulation Interview May Improve Patient-Physician Communication, Trust

Mistrust of health care professionals by some groups of patients may lead to treatment disengagement and health disparities. A report in The American Journal of Psychotherapy describes an interview tool used at patient intake that may be able to facilitate communication about differences in cultural backgrounds between patients and their mental health professionals.

“Elevated disengagement from mental health treatment among Black, Indigenous, and people of color (BIPOC) patients may be due in part to their perceptions that providers misunderstand their experience because of differences in cultural background that are not discussed in therapy,” wrote Neil Krishan Aggarwal, M.D., M.A., of Columbia University Medical Center and New York State Psychiatric Institute and colleagues. “Clinicians can use the CFI [Cultural Formulation Interview] to allow BIPOC patients to describe their experiences within the health care system and to anticipate treatment barriers.”

The 16-item CFI was developed by the DSM-5 cross-cultural issues subgroup. Aggarwal and colleagues implemented the CFI at Flushing Hospital Medical Center, a community hospital in the Queens borough of New York City. Patients were eligible if they were between the ages of 18 and 80, spoke English, and were new to the center. As part of the pilot study, two social workers (one man and one woman who identified as non-Latinx White) agreed to start their intake sessions with the CFI. They attended a two-hour training session that consisted of reading the CFI aloud, watching videos illustrating the use of the CFI with a patient, behavioral simulations to practice responding to questions, and a question-and-answer session with researchers. All patients received $30 in compensation for their time.

The authors analyzed patient responses to the CFI’s final question on the patient-professional relationship: “Sometimes doctors and patients misunderstand each other because they come from different backgrounds or have different expectations. Have you been concerned about this and is there anything that we can do to provide you with the care you need?”

Of the 27 participants (11 men and 16 women) who completed the CFI as part of their intake session for care, two identified as non-Latinx White, 14 as Latinx, eight as non-Latinx Black, and three as non-Latinx Asian. Their primary languages were English, Spanish, and Polish. Their intake diagnoses included anxiety, bipolar, adjustment, psychotic, and somatic symptom disorders.

In response to the final question, 12 patients raised concerns about trusting professionals, particularly stemming from religious, racial-ethnic, gender, and socioeconomic differences. Ten patients had no concerns, simply responding “no” to the final question or explaining that they had no concerns about cultural differences. Three were ambivalent about their relationship with mental health professionals, and two patients were unsure about how to answer the question, responding with “I don’t know.”

“Consistent with the CFI’s approach to helping patients co-construct a narrative about their illness and treatment experiences, clinicians can broach this topic during the initial session to encourage solutions and anticipate problems,” the authors concluded. “Delaying discussions of identity differences may reinforce patient mistrust by communicating that therapists do not care about their experiences.”

For related information, see DSM-5® Handbook On The Cultural Formulation Interview from APA Publishing and the Psychiatric Services article “Using the Cultural Formulation Interview to Build Culturally Sensitive Services.”

(Image: iStock/SDI Productions)

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